Garcia Brás Pedro, Gonçalves António Valentim, Reis João Ferreira, Moreira Rita Ilhão, Pereira-da-Silva Tiago, Rio Pedro, Timóteo Ana Teresa, Silva Sofia, Soares Rui M, Ferreira Rui Cruz
Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal.
NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), 1169-056 Lisbon, Portugal.
Biomedicines. 2023 Aug 6;11(8):2208. doi: 10.3390/biomedicines11082208.
New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B).
Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT.
CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO (pVO) and VE/VCO slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO ≤ 10 mL/kg/min and VE/VCO slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results.
ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.
最近，具有预后益处的新疗法已被引入射血分数降低的心力衰竭（HFrEF）管理中。本研究的目的是评估2009年至2014年（A组）和2015年至2018年（B组）接受心肺运动试验（CPET）的HFrEF队列中心脏移植（HT）当前列入标准的预后预测能力。
对连续接受CPET的HFrEF患者进行随访，观察心脏死亡和紧急HT情况。
487例患者接受了CPET。在36个月的随访中，A组复合终点发生率为19.4%，B组为7.4%。峰值VO（pVO）和VE/VCO斜率是死亡率最强的独立预测因素。国际心脏和肺移植协会（ISHLT）的pVO≤12 mL/kg/min（不耐受β受体阻滞剂时为≤14）和VE/VCO斜率>35的阈值，与A组相比，B组的约登指数分别相似且更低，阳性预测值也更低。pVO≤10 mL/kg/min和VE/VCO斜率>40优于传统临界值。缺血性病因亚分析显示了相似的结果。
ISHLT阈值在当代HFrEF人群中显示出较低的总体预后有效性。可能需要新的参数来改善风险分层。
