术前左心室舒张末期内径指数与 HeartMate 3 植入后的结局相关。
Preoperative left ventricular diastolic dimension index is associated with outcomes after HeartMate 3 implantation.
机构信息
Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
出版信息
Eur J Cardiothorac Surg. 2023 Aug 1;64(2). doi: 10.1093/ejcts/ezad287.
OBJECTIVES
We investigated the association between indexed left ventricular diastolic dimension and clinical outcomes after HeartMate 3 implantation.
METHODS
We retrospectively reviewed patients implanted with the HeartMate 3 at our centre between November 2014 and September 2021. Left ventricular diastolic dimension was assessed via preoperative transthoracic echocardiography and left ventricular diastolic dimension index was calculated as left ventricular diastolic dimension/body surface area. The primary outcome was a composite of death or readmission due to right heart failure or stroke. The cut-off left ventricular diastolic dimension index value most closely associated with outcomes was determined by receiver-operating characteristic curve and restricted cubic spline analyses.
RESULTS
Left ventricular diastolic dimension index measurements were available for 252 of 253 (99.6%) patients. Using a left ventricular diastolic dimension index cut-off value of 33.5 mm/m2, the cohort was divided: left ventricular diastolic dimension index ≤ (n = 131) or > (n = 121) 33.5 mm/m2. While there were no significant differences in age, INTERMACS level and preoperative haemodynamics between groups, patients with smaller left ventricular diastolic dimension index were more likely to have a larger body surface area (2.1 vs 1.9 m2, P < 0.001), ischaemic cardiomyopathy [64 (49%) vs 40 (33%), P = 0.01] and smaller left atrium volume index [40.5 (32.3-54.0) ml/m2 vs 54.0 (43.0-66.8) ml/m2, P < 0.001]. Smaller left ventricular diastolic dimension index patients had significantly worse survival (74% vs 88%, log-rank P = 0.009) and freedom from adverse events (55% vs 73%, log-rank P = 0.005) at 3-year follow-up. Smaller left ventricular diastolic dimension index was independently associated with the composite outcome (Hazard ratio 2.24, P = 0.002).
CONCLUSIONS
Smaller preoperative left ventricular diastolic dimension index is associated with worse outcomes in patients undergoing HeartMate 3 implantation.
目的
我们研究了Indexed left ventricular diastolic dimension（左心室舒张末期内径指数）与 HeartMate 3 植入后的临床结局之间的关联。
方法
我们回顾性分析了 2014 年 11 月至 2021 年 9 月在我们中心植入 HeartMate 3 的患者。通过术前经胸超声心动图评估左心室舒张末期内径，并计算左心室舒张末期内径/体表面积得到左心室舒张末期内径指数。主要结局是因右心衰竭或中风再次入院或死亡的复合终点。通过受试者工作特征曲线和限制立方样条分析确定与结局最密切相关的左心室舒张末期内径指数截断值。
结果
253 例患者中有 252 例（99.6%）提供了左心室舒张末期内径指数测量值。使用左心室舒张末期内径指数截断值 33.5mm/m2，将队列分为左心室舒张末期内径指数≤（n=131）或>（n=121）33.5mm/m2。虽然两组在年龄、INTERMACS 水平和术前血流动力学方面无显著差异，但左心室舒张末期内径指数较小的患者体表面积更大（2.1 vs 1.9m2，P<0.001）、更可能患有缺血性心肌病[64（49%） vs 40（33%），P=0.01]和左心房容积指数更小[40.5（32.3-54.0）ml/m2 vs 54.0（43.0-66.8）ml/m2，P<0.001]。左心室舒张末期内径指数较小的患者在 3 年随访时的生存情况明显较差（74% vs 88%，log-rank P=0.009）和不良事件无复发率较低（55% vs 73%，log-rank P=0.005）。左心室舒张末期内径指数较小与复合结局独立相关（风险比 2.24，P=0.002）。
结论
术前左心室舒张末期内径指数较小与 HeartMate 3 植入患者的预后较差相关。
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