Otto-Meyer Sebastian, Wang Alan P, Griffith Garett J, Gambetta Katheryn, Ward Kendra
Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, USA.
Pediatr Cardiol. 2024 Aug 17. doi: 10.1007/s00246-024-03623-5.
Studies have suggested that pediatric patients with heart transplants (HT) due to congenital heart disease (CHD) perform differently on cardiopulmonary exercise testing compared to pediatric patients with HT due to cardiomyopathy (CM). However, it is not known if this relationship changes over time. The aim of this study was to examine the differences in cardiopulmonary exercise test (CPET) parameters over time between patients with HT due to CHD versus CM. A large single-institution CPET database was used for this study. We conducted a retrospective cohort study of 250 total CPETs from 93 unique patients, examining how patients with HT due to CHD (109 CPETs, 40 unique patients) differed in CPET performance from patients with HT due to CM (141 CPETs, 53 unique patients) from < 2 years post-HT, 2 to < 6 years post-HT, and ≥ 6 years post-HT. There were no differences between patients with HT due to CHD compared to CM in CPETs performed < 2 years post-HT. In CPETs performed 2 to < 6 years post-HT, the CM group had higher maximal HR and percentage of age-predicted maximal heart rate (APMHR) achieved. At ≥ 6 years post-HT, the CM group continued to have higher maximal HR and percentage of APMHR achieved, but also improved HR recovery at one minute. Initial indication for transplant may affect performance on CPETs post-transplant. Patients with HT due to CM have improved chronotropic measures compared to patients with HT due to CHD and these differences are more pronounced with increased time post-HT.
研究表明，因先天性心脏病（CHD）接受心脏移植（HT）的儿科患者与因心肌病（CM）接受HT的儿科患者在心肺运动测试中的表现有所不同。然而，这种关系是否会随时间变化尚不清楚。本研究的目的是检查因CHD与CM接受HT的患者在心肺运动测试（CPET）参数上随时间的差异。本研究使用了一个大型单机构CPET数据库。我们对93名独特患者的250次CPET进行了回顾性队列研究，检查因CHD接受HT的患者（109次CPET，40名独特患者）与因CM接受HT的患者（141次CPET，53名独特患者）在HT后<2年、HT后2至<6年以及HT后≥6年的CPET表现有何不同。在HT后<2年进行CPET时，因CHD接受HT的患者与因CM接受HT的患者之间没有差异。在HT后2至<6年进行CPET时，CM组的最大心率和达到的年龄预测最大心率（APMHR）百分比更高。在HT后≥6年，CM组的最大心率和达到的APMHR百分比仍然更高，但一分钟时的心率恢复也有所改善。移植的初始指征可能会影响移植后CPET的表现。与因CHD接受HT的患者相比，因CM接受HT的患者的变时性指标有所改善，并且随着HT后时间的增加，这些差异更加明显。
