Department of Cell and Molecular Biology, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania.
Emergency Institute for Cardiovascular Diseases and Transplant, 540136 Targu Mures, Romania.
Medicina (Kaunas). 2024 Nov 3;60(11):1801. doi: 10.3390/medicina60111801.
: Cardiac transplantation represents the option for patients with end-stage heart failure (HF), providing the best survival rate. However, the postoperative complications of transplant patients remain a challenge for clinicians. The objective of our study was to evaluate the effect of preoperative chronic HF treatment on the occurrence of in-hospital complications. : We retrospectively included a total of 50 patients who underwent cardiac transplantation between January 2011 and December 2023 from the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures. We correlated the preoperative chronic HF treatment with the postoperative complications by Spearmen's correlation coefficient, respectively. With logistic regression, the associations between the treatment and specific complications were determined. : Significant negative correlations were found between Carvedilol treatment with 2-month mortality (r = -0.30; 95% CI: -0.53--0.02; = 0.03), Ramipril with hospital stay (r = -0.38; 95% CI: -0.60--0.12; < 0.01) and intensive care unit (ICU) stay (r = -0.37; 95% CI: -0.59--0.11; = 0.01), and Spironolactone usage with hospitalization duration (r = -0.28; 95% CI: -0.52--0.01; = 0.04). Furthermore, Carvedilol treatment represented a protective factor against early acute kidney injury (AKI) (OR: 0.22; 95% CI: 0.05-0.91; = 0.03). Spironolactone treatment was a protective factor against AGR (OR: 0.12; 95% CI: 0.02-0.66; = 0.01) treatment, in contrast to angiotensin-converting enzyme inhibitor (ACEI) therapy (OR: 5.30; 95% CI: 1.03-27.17; = 0.04). : Pre-transplant Carvedilol treatment was negatively correlated with the 2-month mortality rate. Ramipril and Spironolactone therapy were negatively correlated with hospitalization duration, and Ramipril was additionally correlated with ICU stay. Moreover, Carvedilol therapy represented a protective factor against early AKI. Pre-transplant Spironolactone was associated with lower event rates of AGR, in contrast to ACEI treatment. Prospective studies with larger cohorts are needed in order to draw drastic conclusions.
心脏移植是治疗终末期心力衰竭（HF）患者的选择，能提供最佳的生存率。然而，移植患者的术后并发症仍然是临床医生面临的挑战。我们的研究目的是评估术前慢性 HF 治疗对住院并发症发生的影响。
我们回顾性纳入了 2011 年 1 月至 2023 年 12 月期间在特兰西瓦尼亚图尔古穆列什心血管疾病紧急研究所进行心脏移植的 50 例患者。我们分别通过 Spearman 相关系数将术前慢性 HF 治疗与术后并发症相关联。通过逻辑回归确定治疗与特定并发症之间的关联。
卡维地洛治疗与 2 个月死亡率呈显著负相关（r = -0.30；95%CI：-0.53--0.02； = 0.03），雷米普利与住院时间（r = -0.38；95%CI：-0.60--0.12； ＜0.01）和重症监护病房（ICU）入住时间（r = -0.37；95%CI：-0.59--0.11； ＜0.01），螺内酯使用与住院时间（r = -0.28；95%CI：-0.52--0.01； = 0.04）。此外，卡维地洛治疗是早期急性肾损伤（AKI）的保护因素（OR：0.22；95%CI：0.05-0.91； = 0.03）。与血管紧张素转换酶抑制剂（ACEI）治疗（OR：5.30；95%CI：1.03-27.17； = 0.04）相比，螺内酯治疗是急性肾损伤后肾小球滤过率降低（AGR）的保护因素（OR：0.12；95%CI：0.02-0.66； = 0.01）。
术前卡维地洛治疗与 2 个月死亡率呈负相关。雷米普利和螺内酯治疗与住院时间呈负相关，雷米普利还与 ICU 入住时间相关。此外，卡维地洛治疗是早期 AKI 的保护因素。与 ACEI 治疗相比，术前螺内酯与较低的 AGR 事件发生率相关。需要进行前瞻性研究，以确定更大的队列，得出更明确的结论。
