Division of Cardiovascular Medicine, Orlando Health Heart & Vascular Institute, Orlando, Florida; Miller College of Business, Ball State University, Muncie, Indiana; Advanced Heart Failure and Transplant Fellowship, Indiana University, Indianapolis, Indiana.
Miller College of Business, Ball State University, Muncie, Indiana.
Am J Cardiol. 2023 Nov 15;207:215-221. doi: 10.1016/j.amjcard.2023.08.125. Epub 2023 Sep 24.
The predicted heart mass (PHM) ratio has recently emerged as a better metric for donor-to-recipient size-matching than weight ratios. It is unknown whether this applies to transplant candidates on left ventricular assist device (LVAD) support. Our study examines if PHM ratio is optimal for size-matching specifically in the LVAD patient population. Patients with LVAD who received a heart transplant from January 1997 to December 2020 in the Scientific Registry of Transplant Recipients database were studied. We compared 5 size-matching metrics, including donor-recipient ratios of weight, height, body mass index, body surface area, and PHM. Single and multivariable Cox proportional hazards models for 1-year mortality were calculated. Our sample consisted of 11,891 patients. In our multivariate analysis, we found that patients in the undersized group with PHM ratios <0.83 had a hazard ratio for 1-year mortality of 1.34 (95% confidence interval 1.08 to 1.65, p = 0.007) suggestive of increased mortality with the use of undersized donors. There was no statistical difference in mortality between the matched (PHM ratio 0.83 to 1.2) and oversized group (PHM ratio ≥1.2). In heart transplant recipients on LVAD support, the PHM ratio provides better risk stratification than other metrics. Use of undersized donor hearts with PHM ratio <0.83 confers higher 1-year mortality. Using oversized donor hearts for transplantation in recipients on LVAD support has no benefit.
预测的心脏质量（PHM）比值最近已成为比体重比更好的供体与受体大小匹配指标。目前尚不清楚这是否适用于左心室辅助装置（LVAD）支持下的移植候选者。我们的研究旨在检查 PHM 比值是否是 LVAD 患者人群中大小匹配的最佳指标。研究对象为 1997 年 1 月至 2020 年 12 月在 Scientific Registry of Transplant Recipients 数据库中接受 LVAD 心脏移植的患者。我们比较了 5 种大小匹配指标，包括供体与受体的体重、身高、体重指数、体表面积和 PHM 比值。计算了用于 1 年死亡率的单变量和多变量 Cox 比例风险模型。我们的样本包括 11891 名患者。在多变量分析中，我们发现 PHM 比值<0.83 的小体型组患者的 1 年死亡率的风险比为 1.34（95%置信区间 1.08 至 1.65，p=0.007），这表明使用小体型供体与死亡率增加相关。在匹配（PHM 比值 0.83 至 1.2）和超大体型组（PHM 比值≥1.2）之间，死亡率无统计学差异。在接受 LVAD 支持的心脏移植受者中，PHM 比值比其他指标提供更好的风险分层。使用 PHM 比值<0.83 的小体型供心会导致更高的 1 年死亡率。对于接受 LVAD 支持的受者，使用超大体型供体进行移植没有获益。
