Stevenson L W, Steimle A E, Fonarow G, Kermani M, Kermani D, Hamilton M A, Moriguchi J D, Walden J, Tillisch J H, Drinkwater D C
Cardiovascular Division, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts 02115.
J Am Coll Cardiol. 1995 Jan;25(1):163-70. doi: 10.1016/0735-1097(94)00357-v.
This study determined the frequency of improvement in peak oxygen uptake and its role in reevaluation of candidates awaiting heart transplantation.
Ambulatory candidates for transplantation usually wait > 6 months to undergo the procedure, and during this period symptoms may lessen, and peak oxygen uptake may improve. Whereas initial transplant candidacy is based increasingly on objective criteria, there are no established guidelines for reevaluation to determine who can leave the active waiting list.
All ambulatory transplant candidates with initial peak oxygen uptake < 14 ml/kg per min were identified. Of 107 such patients listed, 68 survived without early deterioration or transplantation to undergo repeat exercise. A strategy of reevaluation using specific clinical criteria and exercise performance was tested to determine whether patients with improved oxygen uptake could safely be followed without transplantation.
In 38 of the 68 patients, peak oxygen uptake increased by > or = 2 ml/kg per min to a level > or = 12 ml/kg per min after 6 +/- 5 months, together with an increase in anaerobic threshold, peak oxygen pulse and exercise heart rate reserve and a decrease in heart rate at rest. Increased peak oxygen uptake was accompanied by stable clinical status without congestion in 31 of 38 patients, and these 31 were taken off the active waiting list. At 2 years, their actuarial survival rate was 100%, and the survival rate without relisting for transplantation was 85%.
Reevaluation of exercise capacity and clinical status allowed removal of 31 (29%) of 107 ambulatory transplant candidates from the waiting list with excellent early survival despite low peak oxygen uptake on initial testing. The ability to increase peak oxygen uptake, particularly with increased peak oxygen pulse, may indicate improved prognosis as well as functional capacity and, in combination with stable clinical status, may be an indication to defer transplantation in favor of more compromised candidates.
本研究确定了峰值摄氧量改善的频率及其在重新评估心脏移植候选者中的作用。
门诊移植候选者通常要等待6个月以上才能接受手术，在此期间症状可能减轻，峰值摄氧量可能改善。虽然初始移植候选资格越来越多地基于客观标准，但对于重新评估以确定谁可以离开活跃等待名单，尚无既定指南。
识别出所有初始峰值摄氧量<14 ml/kg每分钟的门诊移植候选者。在列出的107例此类患者中，68例存活，未出现早期病情恶化或接受移植，从而能够进行重复运动测试。测试了一种使用特定临床标准和运动表现进行重新评估的策略，以确定峰值摄氧量改善的患者是否可以在不进行移植的情况下安全随访。
68例患者中有38例在6±5个月后峰值摄氧量增加≥2 ml/kg每分钟，达到≥12 ml/kg每分钟，同时无氧阈值、峰值氧脉搏和运动心率储备增加，静息心率降低。38例患者中有31例峰值摄氧量增加且临床状态稳定，无充血症状，这31例患者被从活跃等待名单中移除。2年后，他们的精算生存率为100%，未重新列入移植等待名单的生存率为85%。
对运动能力和临床状态的重新评估使107例门诊移植候选者中的31例（29%）从等待名单中移除，尽管初始测试时峰值摄氧量较低，但早期生存率良好。峰值摄氧量增加的能力，特别是随着峰值氧脉搏增加，可能表明预后改善以及功能能力提高，并且结合稳定的临床状态，可能是推迟移植以支持更有需要的候选者的一个指标。
