Sarver Heart Center, Cardiology Division, Department of Medicine, The University of Arizona, Tucson, Arizona.
Harrington Heart and Vascular Institute, Advanced Heart Failure and Transplant Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Am J Cardiol. 2020 Jul 15;127:52-57. doi: 10.1016/j.amjcard.2020.04.022. Epub 2020 Apr 23.
Peak exercise oxygen consumption (pVO) is an important predictor of prognosis in patients with heart failure (HF). The association between pretransplant pVO and post-transplantation outcomes in HF patients has not been previously studied. We identified adult OHT recipients with available pVO in the United Network for Organ Sharing registry (2000 to 2015). Patients were divided into 3 categories using Weber classification: class B (pVO 16 to 20 ml/kg/min), class C (pVO 10 to 16 ml/kg/min), and class D (pVO <10 ml/kg/min). Postoperative outcomes (mortality, renal failure, rejection) were compared between the groups. A total of 9,623 patients were included in this analysis; the mean age was 54 ± 11 years, 74% were male, 75% were white and 59% had nonischemic etiology of HF. The mean pVO was 11.7 ± 3.6 ml/kg/min: 1,202 (12.5%) in class B, 6,055 (62.9%) in class C, and 2,366 (24.6%) were in class D. At a median follow-up of 6.1 years, 2,730 (28.4%) died. Post-transplantation survival decreased with decreasing pVO; 1 and 5-year survival: B (92%, 80%), C (90%, 79%), and D (87%, 75%), p <0.001 by log-rank. After multiple adjustments, patients in class D had significantly higher post-transplantation mortality compared with class C (Hazard Ratio (HR) 1.21 [1.03 to 1.43], p = 0.02). When analyzed as a continuous variable, each 1 ml/kg/min increase in pVO was associated with 2% decrease in mortality during follow-up (adjusted HR 0.98 [0.96 to 0.99], p <0.001). Patients in class D had significantly prolonged (>14 days) hospitalization (adjusted Odds Ratio (OR) 1.42 [1.20 to 1.68], p <0.001) and a trend toward increased need for dialysis (adjusted OR 1.36 [1.00 to 1.84], p = 0.05) compared with patients in class B. In this large cohort, lower pretransplant pVO was associated with greater mortality and morbidity after OHT. These results suggest that earlier transplantation might improve post-transplantation outcomes in advanced HF patients.
运动峰值摄氧量（pVO）是心力衰竭（HF）患者预后的重要预测指标。HF 患者移植前 pVO 与移植后结局之间的关系尚未被研究过。我们在美国器官共享网络登记处（2000 年至 2015 年）中确定了有可用 pVO 的成人 OHT 受者。患者使用 Weber 分类分为 3 类：B 类（pVO 为 16 至 20 ml/kg/min），C 类（pVO 为 10 至 16 ml/kg/min）和 D 类（pVO<10 ml/kg/min）。比较各组之间的术后结局（死亡率，肾功能衰竭，排斥反应）。这项分析共纳入 9623 例患者；平均年龄为 54±11 岁，74%为男性，75%为白人，59%有非缺血性 HF 病因。平均 pVO 为 11.7±3.6 ml/kg/min：B 类 1202 例（12.5%），C 类 6055 例（62.9%），D 类 2366 例（24.6%）。中位随访 6.1 年后，2730 例（28.4%）死亡。随着 pVO 的降低，移植后生存率降低；1 年和 5 年生存率：B 类（92%，80%），C 类（90%，79%）和 D 类（87%，75%），p<0.001 由对数秩检验。经多次调整后，D 类患者的移植后死亡率明显高于 C 类（危险比（HR）1.21 [1.03 至 1.43]，p=0.02）。作为连续变量进行分析时，pVO 每增加 1 ml/kg/min，随访期间的死亡率降低 2%（调整后的 HR 0.98 [0.96 至 0.99]，p<0.001）。与 B 类患者相比，D 类患者的住院时间明显延长（调整后的优势比（OR）1.42 [1.20 至 1.68]，p<0.001），需要透析的趋势增加（调整后的 OR 1.36 [1.00 至 1.84]，p=0.05）。在这个大型队列中，移植前较低的 pVO 与 OHT 后更大的死亡率和发病率相关。这些结果表明，早期移植可能会改善晚期 HF 患者的移植后结局。
Zotero 插件