Nessler J, Piwowarska W
Klinik Choroby Wieńcowej, Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowe.
Przegl Lek. 1997;54(11):819-21.
Heart transplantation has recently become an accepted method of treating heart failure patients, also in Poland. Criteria of patient selection to heart transplantation and follow-up was based (and in some centers still is) on the assessment of the patients' clinical status according to NYHA classification and on the data on the extend of myocardial damage obtained from echocardiography or ventriculography at rest. However, examinations performed in the resting state do not provide complete information on the patient's clinical status, especially during increased oxygen demand. Recently cardiopulmonary exercise testing (CPX-to measure maximal oxygen consumption) has been increasing used to establish the prognosis in patients with severe heart failure and to define indications to heart transplantation. CPX combines exercise testing with monitoring the air flow and gas exchange. The measurement of oxygen uptake and anaerobic threshold during exercise is an objective, reproducible, safe and non-invasive method to assess cardiac reserve. There is evidence implying that in heart failure patients VO2max is a good short-term indicator of mortality and that its deterioration frequently precedes clinical decompensation. Thus, the parameter may be useful not only in defining the indications, but also in the monitoring the patient's clinical state and timing of heart transplantation.
心脏移植最近已成为治疗心力衰竭患者的一种公认方法，在波兰也是如此。心脏移植患者的选择标准和随访（在一些中心现在仍然如此）基于根据纽约心脏协会（NYHA）分类对患者临床状况的评估，以及从静息状态下的超声心动图或心室造影获得的心肌损伤程度数据。然而，在静息状态下进行的检查并不能提供患者临床状况的完整信息，尤其是在氧需求增加时。最近，心肺运动试验（CPX，用于测量最大耗氧量）越来越多地用于评估重度心力衰竭患者的预后并确定心脏移植的适应症。CPX将运动试验与气流和气体交换监测相结合。运动期间摄氧量和无氧阈值的测量是评估心脏储备的一种客观、可重复、安全且无创的方法。有证据表明，在心力衰竭患者中，最大摄氧量（VO2max）是死亡率的良好短期指标，其恶化往往先于临床失代偿。因此，该参数不仅可能有助于确定适应症，还可用于监测患者的临床状态以及心脏移植的时机。
