Service d'insuffisance cardiaque et transplantation, Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Bron, France.
Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, 54500, France.
ESC Heart Fail. 2021 Dec;8(6):4944-4954. doi: 10.1002/ehf2.13534. Epub 2021 Sep 14.
Abnormal renal function is a common feature in patients on heart transplant waiting lists. This study aimed to identify the haemodynamic parameters associated with decreased estimated glomerular filtration rate (eGFR) in patients listed for heart transplantation (HT) and renal function improvement following HT.
A total of 176 adults (52 years old, 81% men) with available right heart catheterization (RHC) listed in our centre for HT between 2014 and 2019 were studied. Cardiac catheterization measurements were obtained at time of HT listing evaluation. Changes in renal function were assessed between RHC and 6 months after HT. Median eGFR was 63 mL/min/1.73 m at time of RHC. Central venous pressure > 10 mmHg was associated with a two-fold increase in the likelihood of eGFR < 60 mL/min/1.73 m at time of RHC (adjusted odd ratio, 2.2; 95% confidence interval, 1.1-4.7; P = 0.04). In the 134 patients (76%) who underwent HT during follow-up, eGFR decreased by 7.9 ± 29.7 mL/min/1.73 m from RHC to 6 months after HT. In these patients, low cardiac index (<2.1 L/min/m ) at initial RHC was associated with a (adjusted) 6 month post-HT eGFR improvement of 12.2 mL/min/1.73 m (P = 0.018). Patients with eGFR < 60 mL/min/1.73 m and low cardiac index at time of RHC exhibited the greatest eGFR improvement (delta eGFR = 18.3 mL/min/1.73 m ) while patients with eGFR ≥ 60 mL/min/1.73 m and normal cardiac index had a marked decrease in eGFR (delta eGFR = -27.7 mL/min/1.73 m , P < 0.001).
Central venous pressure is the main haemodynamic parameter associated with eGFR < 60 mL/min/1.73 m in patients listed for HT. Low cardiac index prior to HT is associated with post-transplant renal function recovery.
肾功能异常是心脏移植等待名单上患者的常见特征。本研究旨在确定与心脏移植（HT）患者估算肾小球滤过率（eGFR）降低相关的血液动力学参数，并确定 HT 后肾功能的改善情况。
本研究共纳入了 176 名在我们中心接受 HT 治疗的成年人（52 岁，81%为男性），这些患者在 2014 年至 2019 年间接受了右心导管检查（RHC）。在 HT 列名评估时获得心导管测量值。在 RHC 和 HT 后 6 个月之间评估肾功能的变化。RHC 时的中位 eGFR 为 63 mL/min/1.73 m。中心静脉压>10mmHg 与 RHC 时 eGFR<60mL/min/1.73 m 的可能性增加两倍相关（校正比值比，2.2；95%置信区间，1.1-4.7；P=0.04）。在 134 名（76%）接受随访期间接受 HT 的患者中，从 RHC 到 HT 后 6 个月，eGFR 下降了 7.9±29.7 mL/min/1.73 m。在这些患者中，初始 RHC 时的低心指数（<2.1 L/min/m）与 HT 后 6 个月时的 eGFR 改善（校正）12.2 mL/min/1.73 m 相关（P=0.018）。在 RHC 时 eGFR<60 mL/min/1.73 m 和低心指数的患者中，eGFR 的改善最大（delta eGFR=18.3 mL/min/1.73 m），而 eGFR≥60 mL/min/1.73 m 和正常心指数的患者则出现 eGFR 的显著下降（delta eGFR=-27.7 mL/min/1.73 m，P<0.001）。
中心静脉压是与 HT 列名患者 eGFR<60 mL/min/1.73 m 相关的主要血液动力学参数。HT 前的心指数低与移植后肾功能恢复有关。
