Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
Heart Vessels. 2021 May;36(5):659-666. doi: 10.1007/s00380-020-01735-5. Epub 2020 Nov 27.
Cardiac rehabilitation (CR) is recommended to improve exercise capacity after heart transplantation (HTx); however, the effects of marginal donor factors are unclear. Forty-one recipients participated in a 3-month CR program early after HTx (mean age 39 ± 14 years; 88% male). Patients were divided into marginal (≥ 2 marginal donor factors; n = 24) and control groups (< 2 marginal donor factors; n = 17). We examined donor and recipient factors related to change in peak oxygen uptake (peak VO) during the CR program using multiple linear regression analysis. Baseline characteristics were similar between groups, although the mean age was higher in the marginal group (43 ± 13 vs. 34 ± 14 years, p = 0.043). Peak VO and knee extensor muscular strength (KEMS) improved significantly in both groups (p < 0.05), but there were no observed inter-group differences. Multiple analysis revealed change in KEMS (β = 0.52, 95% CI = 0.023-1.01) as an independent predictor of change in peak VO after adjustment for recipients' age, sex, and CR attendance frequency (adjusted R = 0.25, p = 0.0084), whereas marginal donor factors were not a predictor (p = 0.76). The CR program improved exercise capacity in HTx recipients regardless of marginal donor factors, suggesting that recipients of marginal donor hearts should be referred to CR programs.
心脏康复（CR）被推荐用于改善心脏移植（HTx）后的运动能力；然而，边缘供体因素的影响尚不清楚。41 名接受者在 HTx 后早期参加了为期 3 个月的 CR 计划（平均年龄 39±14 岁；88%为男性）。患者被分为边缘组（≥2 个边缘供体因素；n=24）和对照组（<2 个边缘供体因素；n=17）。我们使用多元线性回归分析检查了与 CR 计划中峰值摄氧量（peak VO）变化相关的供体和受体因素。两组间的基线特征相似，尽管边缘组的平均年龄较高（43±13 岁 vs. 34±14 岁，p=0.043）。两组的 peak VO 和膝关节伸肌肌力（KEMS）均显著改善（p<0.05），但两组间无观察到差异。多元分析显示 KEMS 的变化（β=0.52，95%置信区间=0.023-1.01）是调整受体年龄、性别和 CR 参与频率后 peak VO 变化的独立预测因素（调整后的 R=0.25，p=0.0084），而边缘供体因素不是预测因素（p=0.76）。CR 计划改善了 HTx 接受者的运动能力，无论边缘供体因素如何，这表明应向边缘供体心脏的接受者推荐 CR 计划。
