Rose G A, Davies R G, Appadurai I R, Lewis W G, Cho J S, Lewis M H, Williams I M, Bailey D M
Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.
Department of Anaesthetics, University Hospital of Wales, Cardiff, UK.
Exp Physiol. 2018 Nov;103(11):1505-1512. doi: 10.1113/EP087092. Epub 2018 Oct 13.
What is the central question of this study? To what extent cardiorespiratory fitness is impaired in patients with abdominal aortic aneurysmal (AAA) disease and corresponding implications for postoperative survival requires further investigation. What is the main finding and its importance? Cardiorespiratory fitness is impaired in patients with AAA disease. Patients with peak oxygen uptake of <13.1 ml O kg min and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥34 are associated with increased risk of postoperative mortality at 2 years. These findings demonstrate that cardiorespiratory fitness can predict mid-term postoperative survival in AAA patients, which may help to direct care provision.
Preoperative cardiopulmonary exercise testing is a standard assessment of cardiorespiratory fitness (CRF) and risk stratification. However, to what extent CRF is impaired in patients undergoing surgical repair of abdominal aortic aneurysm (AAA) disease and the corresponding implications for postoperative outcome requires further investigation. We measured CRF during an incremental exercise test to exhaustion using online respiratory gas analysis in patients with AAA disease (n = 124, aged 72 ± 7 years) and healthy sedentary control subjects (n = 104, aged 70 ± 7 years). Postoperative survival was examined for association with CRF, and threshold values were calculated for independent predictors of mortality. Patients who underwent preoperative cardiopulmonary exercise testing before surgical repair had lower CRF [age-adjusted mean difference of 12.5 ml O kg min for peak oxygen uptake ( ), P < 0.001 versus control subjects]. After multivariable analysis, both and the ventilatory equivalent for carbon dioxide at anaerobic threshold ( ) were independent predictors of mid-term postoperative survival (2 years). Hazard ratios of 5.27 (95% confidence interval 1.62-17.14, P = 0.006) and 3.26 (95% confidence interval 1.00-10.59, P = 0.049) were observed for < 13.1 ml O kg min and ≥ 34, respectively. Thus, CRF is lower in patients with AAA, and those with a < 13.1 ml O kg min and ≥ 34 are associated with a markedly increased risk of postoperative mortality. Collectively, our findings demonstrate that CRF can predict mid-term postoperative survival in AAA patients, which may help to direct care provision.
本研究的核心问题是什么？腹主动脉瘤（AAA）疾病患者的心肺适能受损程度以及对术后生存的相应影响有待进一步研究。主要发现及其重要性是什么？AAA疾病患者的心肺适能受损。峰值摄氧量<13.1 ml O₂/kg/min且无氧阈时二氧化碳通气当量≥34的患者在2年时术后死亡风险增加。这些发现表明，心肺适能可预测AAA患者术后中期生存情况，这可能有助于指导医疗护理。
术前心肺运动试验是评估心肺适能（CRF）和风险分层的标准方法。然而，接受腹主动脉瘤（AAA）疾病手术修复的患者心肺适能受损程度以及对术后结局的相应影响有待进一步研究。我们使用在线呼吸气体分析，在递增运动试验至力竭过程中测量了AAA疾病患者（n = 124，年龄72±7岁）和健康久坐对照者（n = 104，年龄70±7岁）的CRF。研究术后生存情况与CRF的关联，并计算死亡率独立预测因素的阈值。在手术修复前接受术前心肺运动试验的患者CRF较低[峰值摄氧量（ ）的年龄校正平均差异为12.5 ml O₂/kg/min，与对照者相比，P < 0.001]。多变量分析后， 和无氧阈时二氧化碳通气当量（ ）均为术后中期生存（2年）的独立预测因素。对于 < 13.1 ml O₂/kg/min和 ≥ 34，观察到的风险比分别为5.27（95%置信区间1.62 - 17.14，P = 0.006）和3.26（95%置信区间1.00 - 10.59，P = 0.049）。因此，AAA患者的CRF较低， < 13.1 ml O₂/kg/min且 ≥ 34的患者术后死亡风险显著增加。总体而言，我们的发现表明，CRF可预测AAA患者术后中期生存情况，这可能有助于指导医疗护理。
