Department of Medicine (DAME), University of Udine, Udine, Italy.
Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Transpl Int. 2024 Mar 8;37:11075. doi: 10.3389/ti.2024.11075. eCollection 2024.
Metabolic Syndrome (MetS), a multifactorial condition that increases the risk of cardio-vascular events, is frequent in Heart-transplant (HTx) candidates and worsens with immunosuppressive therapy. The aim of the study was to analyze the impact of MetS on long-term outcome of HTx patients. Since 2007, 349 HTx patients were enrolled. MetS was diagnosed if patients met revised NCEP-ATP III criteria before HTx, at 1, 5 and 10 years of follow-up. MetS was present in 35% of patients pre-HTx and 47% at 1 year follow-up. Five-year survival in patients with both pre-HTx (65% vs. 78%, < 0.01) and 1 year follow-up MetS (78% vs 89%, < 0.01) was worst. At the univariate analysis, risk factors for mortality were pre-HTx MetS (HR 1.86, < 0.01), hypertension (HR 2.46, < 0.01), hypertriglyceridemia (HR 1.50, p=0.03), chronic renal failure (HR 2.95, < 0.01), MetS and diabetes at 1 year follow-up (HR 2.00, < 0.01; HR 2.02, < 0.01, respectively). MetS at 1 year follow-up determined a higher risk to develop Coronary allograft vasculopathy at 5 and 10 year follow-up (25% vs 14% and 44% vs 25%, < 0.01). MetS is an important risk factor for both mortality and morbidity post-HTx, suggesting the need for a strict monitoring of metabolic disorders with a careful nutritional follow-up in HTx patients.
代谢综合征（MetS）是一种多因素疾病，会增加心血管事件的风险，在心脏移植（HTx）患者中很常见，并且随着免疫抑制治疗而恶化。本研究旨在分析 MetS 对 HTx 患者长期预后的影响。自 2007 年以来，共纳入 349 名 HTx 患者。如果患者在 HTx 前、1、5 和 10 年随访时符合修订后的 NCEP-ATP III 标准，则诊断为 MetS。HTx 前患者中有 35%存在 MetS，1 年随访时为 47%。有 HTx 前 MetS（65%比 78%， < 0.01）和 1 年随访时 MetS（78%比 89%， < 0.01）的患者 5 年生存率最差。单因素分析表明，死亡的危险因素包括 HTx 前 MetS（HR 1.86， < 0.01）、高血压（HR 2.46， < 0.01）、高三酰甘油血症（HR 1.50，p=0.03）、慢性肾衰竭（HR 2.95， < 0.01）、1 年随访时的 MetS 和糖尿病（HR 2.00， < 0.01；HR 2.02， < 0.01）。1 年随访时的 MetS 增加了 5 年和 10 年随访时发生冠状动脉移植血管病的风险（25%比 14%和 44%比 25%， < 0.01）。MetS 是 HTx 后死亡和发病的重要危险因素，提示需要对 HTx 患者的代谢紊乱进行严格监测，并进行精心的营养随访。
