Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Thoracic Surgery, Chronic Thromboembolic Pulmonary Hypertension Program, University Health Network, Toronto, Ontario, Canada.
Ann Thorac Surg. 2022 Feb;113(2):444-451. doi: 10.1016/j.athoracsur.2021.01.066. Epub 2021 Mar 3.
Pulmonary endarterectomy (PEA) is a curative procedure for patients with chronic thromboembolic pulmonary hypertension. Body composition and exercise capacity have been associated with adverse outcomes in patients undergoing cardiothoracic operations, but their significance with PEA is unclear. We evaluated the association of body composition and 6-minute walk distance (6MWD) with disease severity, hospital length of stay, discharge disposition, and postoperative functional recovery.
This was a retrospective, single-center cohort study of patients who underwent PEA (January 2014-December 2017). Body composition (skeletal muscle mass and adiposity cross-sectional area) was quantified using thoracic computed tomography with sliceOmatic (TomoVision, Magog, QC, Canada) software. Body mass index was calculated. Association of body composition measures and 6MWD with clinical outcomes was evaluated using multivariable regression models.
The study included 127 patients (42% men), aged 58 ± 14 years; body mass index was 31 ± 7 kg/m and 6MWD was 361 ± 165 m). Muscle and 6MWD were associated with disease severity measures. Of those surviving hospitalization (n = 125), a greater 6MWD was associated with a shorter hospital stay (1.9 median days per 100 m; p < .001) and higher likelihood of being discharged directly home from hospital (odds ratio, 2.1 per 100 m; P = .004), independent of age, sex, and body mass index. Those with a lower preoperative 6MWD (per 100 m) had a greater increase in their postoperative 6MWD (52 m; P < .0001), independent of age, sex, and body mass index. Body composition measures were not associated with hospital outcomes or exercise capacity in the first year postoperatively.
Exercise capacity was a more prognostic marker of PEA outcomes compared with body composition. Future research is needed to explore pre-PEA rehabilitation strategies.
肺动脉内膜剥脱术（PEA）是治疗慢性血栓栓塞性肺动脉高压患者的一种根治性手术。在接受心胸外科手术的患者中，身体成分和运动能力与不良结局相关，但在 PEA 患者中其意义尚不清楚。我们评估了身体成分和 6 分钟步行距离（6MWD）与疾病严重程度、住院时间、出院去向和术后功能恢复的关系。
这是一项回顾性的、单中心队列研究，纳入了 2014 年 1 月至 2017 年 12 月期间接受 PEA 的患者。使用 TomoVision（加拿大麦格的 Magog，QC）切片软件对胸部计算机断层扫描（CT）进行量化，以评估身体成分（骨骼肌质量和脂肪横截面积）。采用多变量回归模型评估身体成分指标和 6MWD 与临床结局的关系。
研究纳入了 127 名患者（42%为男性），年龄 58 ± 14 岁；体重指数为 31 ± 7kg/m2，6MWD 为 361 ± 165m）。肌肉量和 6MWD 与疾病严重程度指标相关。在幸存住院的患者中（n=125），6MWD 越大，住院时间越短（每 100m 减少 1.9 天；p<0.001），出院时直接回家的可能性越高（优势比，每 100m 增加 2.1；p=0.004），独立于年龄、性别和体重指数。术前 6MWD 越低（每 100m）的患者，术后 6MWD 增加越多（增加 52m；p<0.0001），独立于年龄、性别和体重指数。在术后 1 年内，身体成分指标与住院结局或运动能力均无相关性。
与身体成分相比，运动能力是 PEA 结局更具预后意义的指标。需要进一步研究以探讨 PEA 前的康复策略。
