Di Salvo T G, Koelling T M, Muller-Ehmsen J, Schmidt U, Semigran M J, Dec G W
Massachusetts General Hospital Heart Failure and Cardiac Transplantation Center, Boston, Mass. 02114, USA.
J Heart Lung Transplant. 1997 Aug;16(8):869-77.
The purpose of this study was to identify predictors of survival in patients referred for heart transplantation evaluation who had a peak oxygen uptake of 10 to 14 ml/kg/min measured during initial cardiopulmonary exercise testing.
Seventy-two patients were identified retrospectively from a database of 304 patients who underwent heart transplantation evaluations at our center from 1985 to 1995. All 72 patients underwent right-sided heart catheterization and first-pass right and left ventricular radionuclide ventriculography during cardiopulmonary exercise testing.
There were 14 women and 58 men in the study (mean age 52 +/- 9 years, 80% male, 79% New York Heart Association class III/IV, left ventricular ejection fraction of 0.24 +/- 0.9, and left ventricular end-diastolic volume index of 144 +/- 59 ml). During a mean follow-up of 19 +/- 23 months, two women and 32 men (47%) reached the combined end point of death (n = 20) or pretransplantation admission for inotropic or mechanical support (n = 14). For the entire cohort, analysis of clinical, ventriculographic, and exercise parameters identified female sex, younger age, and age/ sex-adjusted peak oxygen uptake as independent predictors of survival. In men only, age, left ventricular end-diastolic volume index, and age/sex adjusted peak oxygen uptake were independent predictors of survival.
Among patients referred for heart transplantation evaluation with a peak oxygen uptake between 10 to 14 ml/kg/min, younger age, female sex, and higher age/ sex-adjusted peak oxygen uptake predict longer survival to the combined end point of death or pretransplantation admission for inotropic or mechanical support. These measures may be useful in additional risk stratification of such patients.
本研究的目的是确定在初次心肺运动试验中测得的峰值摄氧量为10至14 ml/kg/min的心脏移植评估患者的生存预测因素。
从1985年至1995年在我们中心接受心脏移植评估的304例患者的数据库中回顾性确定了72例患者。所有72例患者在心肺运动试验期间均接受了右侧心导管检查以及首次通过的右心室和左心室放射性核素心室造影。
研究中有14名女性和58名男性（平均年龄52±9岁，80%为男性，79%为纽约心脏协会III/IV级，左心室射血分数为0.24±0.9，左心室舒张末期容积指数为144±59 ml）。在平均19±23个月的随访期间，2名女性和32名男性（47%）达到了死亡（n = 20）或因使用正性肌力药物或机械支持而在移植前入院（n = 14）的联合终点。对于整个队列，对临床、心室造影和运动参数的分析确定女性、年轻年龄以及年龄/性别调整后的峰值摄氧量是生存的独立预测因素。仅在男性中，年龄、左心室舒张末期容积指数以及年龄/性别调整后的峰值摄氧量是生存的独立预测因素。
在峰值摄氧量为10至14 ml/kg/min的心脏移植评估患者中，年轻年龄、女性以及较高的年龄/性别调整后的峰值摄氧量可预测至死亡或因使用正性肌力药物或机械支持而在移植前入院这一联合终点的更长生存期。这些指标可能有助于对此类患者进行额外的风险分层。
