Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
Adv Respir Med. 2021;89(2):115-123. doi: 10.5603/ARM.a2021.0034.
Investigations have described a correlation between the severity of heart failure and the severity of pulmonary function abnormalities. In this study, we investigated the association of resting spirometric parameters, lung diffusion for carbon monoxide (DLCO), and the transfer coefficient (KCO) with hemodynamic variables and outcomes in a cohort of heart transplant candidates.
Between January 2018 and January 2020, a total of 100 patients with advanced heart failure who were scheduled for right heart catheterization (RHC) as a pre-transplant evaluation measure were enrolled. Spirometry and DLCO were performed in all patients within 24 hours of their RHC. All selected patients were followed for a median (IQR) time of 6 (2-12) months. The end points of interest were heart failure-related mortality and a combined event involving HF-related mortality, heart transplantation (HTX), and need for the placement of a left ventricular assist device (LVAD).
Among 846 patients scheduled for RHC, a total of 100 patients (25% female) with a mean (SD) age of 38.5 (12.8) were enrolled. There was a significant correlation between FEV1/FVC and CVP (r = -0.22, p = 0.02), PCWP (r = -0.4, p < 0.001), mPAP (r = -0.45, p < 0.001), and PVR (r = -0.32, p = 0.001). The cardiac output correlated with DLCO (r = 0.3, p = 0.008). Spirometry parameters, DLCO parameters, and hemodynamic parameters did not correlate with the combined event. Among the several variables, only PVR had an independent association with the combined event.
Both mechanical and gas diffusion parameters of the lung were not associated with outcomes in the homogeneous group of heart transplant candidates.
研究表明，心力衰竭的严重程度与肺功能异常的严重程度之间存在相关性。本研究旨在调查静息肺功能参数、一氧化碳弥散量（DLCO）和转移系数（KCO）与血流动力学变量以及心脏移植候选者队列中的预后之间的关系。
2018 年 1 月至 2020 年 1 月，共纳入 100 例因心力衰竭进展拟行右心导管检查（RHC）的患者，作为移植前评估的一部分。所有患者均在 RHC 后 24 小时内进行肺功能检查和 DLCO 检查。所有入选患者的中位（IQR）随访时间为 6（2-12）个月。主要研究终点为心力衰竭相关死亡率和包括心力衰竭相关死亡率、心脏移植（HTX）和左心室辅助装置（LVAD）植入需求在内的复合事件。
在 846 例拟行 RHC 的患者中，共纳入 100 例（25%为女性）患者，平均（SD）年龄为 38.5（12.8）岁。FEV1/FVC 与 CVP（r = -0.22，p = 0.02）、PCWP（r = -0.4，p < 0.001）、mPAP（r = -0.45，p < 0.001）和 PVR（r = -0.32，p = 0.001）之间存在显著相关性。心输出量与 DLCO（r = 0.3，p = 0.008）相关。肺功能参数、DLCO 参数和血流动力学参数与复合事件无相关性。在多个变量中，只有 PVR 与复合事件有独立相关性。
在同质的心脏移植候选者群体中，肺的机械和气体扩散参数与预后均无相关性。
