Renlund D G, Taylor D O, Ensley R D, O'Connell J B, Gilbert E M, Bristow M R, Ma H, Yanowitz F G
Division of Cardiology, University of Utah Health Sciences Center, Salt Lake City 84132, USA.
J Heart Lung Transplant. 1996 Jan;15(1 Pt 1):16-24.
For incompletely understood reasons, cardiac transplant recipients achieve only 60% to 70% of predicted values for maximal exercise capacity. The objective was to determine the characteristics of cardiac transplant recipients that are predictive of exercise capacity.
One hundred ten patients underwent maximal exercise testing using a modified Naughton protocol 26 +/- 1 months after transplantation. Recipient characteristics, resting hemodynamic variables and exercise parameters were compared using univariate and multivariate analyses.
The average maximum heart rate was 85% of predicted, and the average peak oxygen consumption (Vo2) was 17.7 +/- 0.3 ml/kg/min (64% of predicted). Pretransplant status, etiology of heart failure, ischemic time, degree of HLA disparity, cumulative corticosteroid exposure, and number of rejection episodes failed to correlate with any exercise parameter. Older recipient age and female gender were associated with greater values for the proportion of the predicted peak Vo2 (p < 0.001 for age; p = 0.001 for gender). Older donor age was the strongest independent predictor of a decreased chronotropic response (p < 0.001) and was a weak predictor of decreased peak Vo2 (p = 0.014). Even in the multivariate analysis, maintenance prednisone dose negatively impacts exercise duration (p = 0.05), peak Vo2 (p = 0.035) and percent of predicted peak Vo2 (p = 0.032). Of all characteristics tested, pulmonary vascular resistance within 24 hours of exercise most powerfully predicts exercise duration (p = 0.002) and peak Vo2 (p = 0.001).
Female recipients and older recipients have a lower absolute exercise capacity, but achieve a greater proportion of their predicted capacity. Recipients of older donor hearts and those receiving chronic corticosteroids have decreased exercise capacity. Pulmonary vascular resistance is inversely correlated with exercise capacity.
由于一些尚未完全明了的原因，心脏移植受者的最大运动能力仅达到预测值的60%至70%。目的是确定可预测心脏移植受者运动能力的特征。
110例患者在移植后26±1个月采用改良的诺顿方案进行最大运动测试。使用单因素和多因素分析比较受者特征、静息血流动力学变量和运动参数。
平均最大心率为预测值的85%，平均峰值耗氧量（Vo2）为17.7±0.3 ml/kg/min（预测值的64%）。移植前状态、心力衰竭病因、缺血时间、HLA配型差异程度、累积皮质类固醇暴露量和排斥反应发作次数与任何运动参数均无相关性。受者年龄较大和女性与预测峰值Vo2的比例较高相关（年龄p<0.001；性别p = 0.001）。供者年龄较大是心率变时反应降低的最强独立预测因素（p<0.001），也是峰值Vo2降低的弱预测因素（p = 0.014）。即使在多因素分析中，泼尼松维持剂量对运动持续时间（p = 0.05）、峰值Vo2（p = 0.035）和预测峰值Vo2的百分比（p = 0.032）也有负面影响。在所有测试的特征中，运动后24小时内的肺血管阻力对运动持续时间（p = 0.002）和峰值Vo2（p = 0.001）的预测能力最强。
女性受者和老年受者的绝对运动能力较低，但达到其预测能力的比例较高。接受老年供者心脏的受者和接受慢性皮质类固醇治疗的受者运动能力下降。肺血管阻力与运动能力呈负相关。
