University of Chicago, Chicago, IL, USA.
MedStar Washington Hospital Center, Washington, DC, USA.
J Artif Organs. 2021 Dec;24(4):425-432. doi: 10.1007/s10047-021-01261-9. Epub 2021 Apr 1.
Preoperative cardiopulmonary exercise testing (CPET) is well validated for prognostication before advanced surgical heart failure therapies, but its role in prognostication after LVAD surgery has never been studied. VE/VCO2 slope is an important component of CPET which has direct pathophysiologic links to right ventricular (RV) performance. We hypothesized that VE/VCO slope would prognosticate RV dysfunction after LVAD. All CPET studies from a single institution were collected between September 2009 and February 2019. Patients who ultimately underwent LVAD implantation were selectively analyzed. Peak VO2 and VE/VCO2 slope were measured for all patients. We evaluated their association with hemodynamic, echocardiographic and clinical markers of RV dysfunction as well mortality. Patients were stratified into those with a ventilatory class of III or greater. (VE/VCO2 slope of ≥ 36, n = 43) and those with a VE/VCO2 slope < 36 (n = 27). We compared the mortality between the 2 groups, as well as the hemodynamic, echocardiographic and clinical markers of RV dysfunction. 570 patients underwent CPET testing. 145 patients were ultimately referred to the advanced heart failure program and 70 patients later received LVAD implantation. Patients with VE/VCO2 slope of ≥ 36 had higher mortality (30.2% vs. 7.4%, p = 0.02) than patients with VE/VCO2 slope < 36 (n = 27). They also had a higher incidence of clinically important RVF (Acute severe 9.3% vs. 0%, Severe 32.6% vs 25.9%, p = 0.03). Patients with a VE/VCO2 slope ≥ 36 had a higher CVP than those with a lower VE/VCO2 slope (11.2 ± 6.1 vs. 6.0 ± 4.8 mmHg, p = 0.007), and were more likely to have a RA/PCWP ≥ 0.63 (65% vs. 19%, p = 0.008) and a PAPI ≤ 2 (57% vs. 13%, p = 0.008). In contrast, peak VO2 < 12 ml/kg/min was not associated with postoperative RV dysfunction or mortality. Elevated preoperative VE/VCO2 slope is a predictor of postoperative mortality, and is associated with postoperative clinical and hemodynamic markers of impaired RV performance.
术前心肺运动试验 (CPET) 对预测高级心脏衰竭治疗前的预后具有良好的验证作用，但它在 LVAD 手术后的预后中的作用从未被研究过。VE/VCO2 斜率是 CPET 的一个重要组成部分，它与右心室 (RV) 功能具有直接的病理生理联系。我们假设 VE/VCO 斜率将预测 LVAD 术后 RV 功能障碍。从 2009 年 9 月至 2019 年 2 月，从一家机构收集了所有 CPET 研究。选择性分析最终接受 LVAD 植入的患者。对所有患者测量峰值 VO2 和 VE/VCO2 斜率。我们评估了它们与 RV 功能障碍的血流动力学、超声心动图和临床标志物以及死亡率的关系。患者分为通气分级 III 级或更高的患者 (VE/VCO2 斜率 ≥ 36，n = 43) 和 VE/VCO2 斜率 < 36 的患者 (n = 27)。我们比较了两组之间的死亡率，以及 RV 功能障碍的血流动力学、超声心动图和临床标志物。570 名患者接受了 CPET 检查。145 名患者最终被转介到高级心力衰竭项目，70 名患者随后接受了 LVAD 植入。VE/VCO2 斜率 ≥ 36 的患者死亡率(30.2% vs. 7.4%，p = 0.02)高于 VE/VCO2 斜率 < 36 的患者(27 名)。他们也有更高的临床重要的 RVF 发生率(急性严重 9.3% vs. 0%，严重 32.6% vs. 25.9%，p = 0.03)。VE/VCO2 斜率 ≥ 36 的患者的 CVP 高于 VE/VCO2 斜率较低的患者(11.2 ± 6.1 vs. 6.0 ± 4.8mmHg，p = 0.007)，并且更有可能有 RA/PCWP ≥ 0.63(65% vs. 19%，p = 0.008)和 PAPI ≤ 2(57% vs. 13%，p = 0.008)。相比之下，峰值 VO2 < 12ml/kg/min 与术后 RV 功能障碍或死亡率无关。术前 VE/VCO2 斜率升高是术后死亡率的预测因子，并与术后 RV 功能障碍的临床和血流动力学标志物相关。
