心肺运动试验在胃癌和食管癌手术患者心血管风险评估中的应用：一项前瞻性干预队列研究的结果。
Cardiopulmonary exercise testing for cardiovascular risk assessment in patients undergoing gastric and oesophageal cancer surgery: results from a prospective interventional cohort study.
机构信息
Clinic for Cardiology, Sechenov University, Moskva, Russian Federation.
Research Center "Digital Biodesign and Personalized Healthcare"; Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, Sechenov University, Moskva, Russian Federation.
出版信息
Open Heart. 2022 Jul;9(2). doi: 10.1136/openhrt-2021-001932.
BACKGROUND
Cardiopulmonary exercise testing (CPET) has shown to be useful for preoperative risk stratification in various types of intra-abdominal and thoracic surgery. However, data about the predictive value of CPET for cardiovascular outcome after gastric or oesophageal cancer surgery are inconclusive. The aim of this study was to evaluate the prognostic value of CPET parameters for the prediction of cardiovascular complications in patients with this type of surgery.
METHODS
This is a prospective single-centre interventional cohort study including 200 consecutive patients who underwent elective surgery for oesophageal and/or gastric cancer. Symptom-limited CPET was performed preoperatively to evaluate the potential of various test-derived parameters including anaerobic threshold (AT) to predict cardiovascular complications within 30 days after surgery.
RESULTS
200 patients (mean age 68±14.2 years) met inclusion and exclusion criteria: oesophageal surgery 54 pts, gastric surgery 132 pts and combined oesophageal/gastric surgery 14 pts. 41/200 pts (20.5%) experienced cardiovascular complications during and within 30 days after surgery including 4 non-fatal myocardial infarctions (2%), 1 stroke (0.5%); 6 dead from cardiovascular causes (3%) and less serious complications in 30 patients (15%) including angina attacks and antiarrhythmic therapy for ventricular arrhythmias or for atrial fibrillation/flutter. Results from preoperative CPET indicate that an AT level below 11 mL/kg/min was highly predictive for any cardiovascular complication (p=0.02, OR 6.33, 95% CI 1.78 to 22.47). An AT level <9.5 had the best predictive accuracy for major perioperative cardiac complications (sensitivity 93%, specificity 68%, positive predicative value 75%, negative predicative value 98.8%).
CONCLUSION
CPET is a useful perioperative risk assessment tool for patients undergoing surgery for oesophageal and gastric cancer, which carries a particularly high risk for cardiovascular complications. An AT <9.5 mL/kg/min turned out to be the most reliable predictor for major cardiovascular complications.
背景
心肺运动测试（CPET）已被证明可用于各种类型的腹内和胸内手术的术前风险分层。然而，CPET 预测胃或食道癌手术后心血管结局的数据尚无定论。本研究旨在评估 CPET 参数对这类手术患者心血管并发症预测的预后价值。
方法
这是一项前瞻性单中心干预性队列研究，纳入了 200 例连续接受择期胃或食管及胃手术的患者。术前进行症状限制的 CPET 以评估各种测试衍生参数的潜能，包括无氧阈值（AT），以预测术后 30 天内的心血管并发症。
结果
200 例患者（平均年龄 68±14.2 岁）符合纳入和排除标准：食管手术 54 例，胃手术 132 例，食管/胃联合手术 14 例。200 例患者中有 41 例（20.5%）在手术中和术后 30 天内发生心血管并发症，包括 4 例非致命性心肌梗死（2%）、1 例中风（0.5%）；6 例死于心血管原因（3%）和 30 例患者出现较轻的并发症，包括心绞痛发作和抗心律失常治疗室性心律失常或心房颤动/扑动。术前 CPET 结果表明，AT 水平低于 11 mL/kg/min 对任何心血管并发症具有高度预测性（p=0.02，OR 6.33，95%CI 1.78 至 22.47）。AT 水平<9.5 对围手术期主要心脏并发症具有最佳预测准确性（敏感性 93%，特异性 68%，阳性预测值 75%，阴性预测值 98.8%）。
结论
CPET 是一种有用的围手术期风险评估工具，适用于接受食管和胃癌症手术的患者，这些患者存在心血管并发症的风险特别高。AT<9.5 mL/kg/min 是主要心血管并发症的最可靠预测指标。
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