Hughes Dempsey L, Lizaola-Mayo Blanca, Wheatley-Guy Courtney M, Vargas Hugo E, Bloomer Pamela M, Wolf Cody, Carey Elizabeth J, Forman Daniel E, Duarte-Rojo Andres
Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL.
Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ.
Transplant Direct. 2024 Nov 15;10(12):e1725. doi: 10.1097/TXD.0000000000001725. eCollection 2024 Dec.
Cardiovascular disease and physical decline are prevalent and associated with morbidity/mortality in liver transplant (LT) patients. Cardiopulmonary exercise testing (CPX) provides comprehensive cardiopulmonary and exercise response assessments. We investigated cardiorespiratory fitness (CRF) and cardiac stress generated during CPX in LT candidates.
LT candidates at 2 centers underwent CPX. Standard-of-care cardiac stress testing (dobutamine stress echocardiography, DSE) results were recorded. Physical function was assessed with liver frailty index and 6-min walk test. CPX/DSE double products were calculated to quantify cardiac stress. To better study the association of CPX-derived metrics with physical function, the cohort was divided into 2 groups based on 6-min walk test median (372 m).
Fifty-four participants (62 ± 8 y; 65% men, Model for End-Stage Liver Disease-Na 14 [10-18]) underwent CPX. Peak oxygen consumption was 14.1 mL/kg/min for an anerobic threshold of 10.2 mL/kg/min, with further CRF decline in the lower 6MWT cohort despite lack of liver frailty index-frailty in 90%. DSE was nondiagnostic in 18% versus 4% of CPX ( = 0.058). All CPX were negative for ischemia. A double product of ≥25 000 was observed in 32% of CPX and 11% of DSE ( = 0.020). Respiratory function testing was normal. No patient presented major cardiovascular events at 30 d post-LT.
CPX provided efficient and effective combined cardiopulmonary risk and frailty assessments of LT candidates in a 1-stop test. The CRF was found to be very low despite preserved physical function or lack of frailty.
心血管疾病和身体机能衰退在肝移植（LT）患者中普遍存在，且与发病率/死亡率相关。心肺运动试验（CPX）可提供全面的心肺和运动反应评估。我们调查了LT候选者在CPX期间的心肺适能（CRF）和心脏应激情况。
2个中心的LT候选者接受CPX。记录标准护理心脏应激试验（多巴酚丁胺负荷超声心动图，DSE）结果。用肝脏脆弱指数和6分钟步行试验评估身体功能。计算CPX/DSE双乘积以量化心脏应激。为更好地研究CPX衍生指标与身体功能的关联，根据6分钟步行试验中位数（372米）将队列分为2组。
54名参与者（62±8岁；65%为男性，终末期肝病模型-钠14[10-18]）接受了CPX。峰值耗氧量为14.1毫升/千克/分钟，无氧阈值为10.2毫升/千克/分钟，尽管90%的患者没有肝脏脆弱指数-虚弱，但较低6MWT队列中的CRF进一步下降。DSE在18%的患者中未得出诊断结果，而CPX为4%（P=0.058）。所有CPX的缺血检查均为阴性。32%的CPX和11%的DSE观察到双乘积≥25000（P=0.020）。呼吸功能测试正常。LT术后30天无患者出现重大心血管事件。
CPX在一次检查中为LT候选者提供了高效且有效的心肺风险和虚弱联合评估。尽管身体功能保留或不存在虚弱，但发现CRF非常低。
