慢性重度心力衰竭患者与左心室辅助装置患者运动表现的比较。
Comparison of exercise performance in patients with chronic severe heart failure versus left ventricular assist devices.
作者信息
Mancini D, Goldsmith R, Levin H, Beniaminovitz A, Rose E, Catanese K, Flannery M, Oz M
机构信息
Divisions of Circulatory Physiology, Cardiology, and Cardiothoracic Surgery, Columbia Presbyterian Medical Center, New York, NY, USA.
出版信息
Circulation. 1998 Sep 22;98(12):1178-83. doi: 10.1161/01.cir.98.12.1178.
BACKGROUND
Left ventricular assist devices (LVADs) are frequently used as a bridge to cardiac transplantation and may be useful as long-term therapy. The purpose of this study was to compare the exercise performance of LVAD patients with that of ambulatory heart failure patients.
METHODS AND RESULTS
Exercise testing with hemodynamic and respiratory gas measurements was performed in 65 congestive heart failure (CHF) patients (age 53+/-10 years) and 20 LVAD patients (age 49+/-8 years). Peak Vo2 was significantly higher in the LVAD than the CHF patients (CHF, 12+/-3; LVAD, 15. 9+/-3.8 mL . kg-1 . min-1; P<0.001), as was the Vo2 at the anaerobic threshold (CHF, 8.1+/-2.1; LVAD, 12.2+/-2.9 mL . kg-1 . min-1; P<0.001). At rest, mean arterial blood pressure (CHF, 87+/-11; LVAD, 94+/-9 mm Hg) and cardiac output (CHF, 4+/-1; LVAD, 4. 9+/-0.9 L/min) were increased, whereas mean pulmonary artery pressure (CHF, 28+/-11; LVAD, 18+/-4 mm Hg) and pulmonary artery wedge pressure (CHF, 16+/-10; LVAD 5+/-3 mm Hg) were reduced (all P<0.01). At peak exercise, heart rate (CHF,125+/-24; LVAD, 148+/-24 bpm), blood pressure (CHF, 87+/-14; LVAD,96+/-12 mm Hg), and cardiac output (CHF, 7.6+/-2.2; LVAD, 11.2+/-2.6 L/min) were higher (all P<0. 01), whereas mean pulmonary artery pressure (CHF, 48+/-12; LVAD, 30+/-5 mm Hg) and mean pulmonary capillary wedge pressure (CHF, 31+/-11; LVAD, 14+/-6 mm Hg) were lower in the LVAD group (both P<0. 001). In the LVAD patients, Fick cardiac output was higher than LVAD flow sensor value measurements (Fick, 11.6+/-2.5; LVAD, 8.1+/-1.2 L/min; P<0.001).
CONCLUSIONS
Hemodynamic measurements at rest and during exercise are significantly improved in patients with devices compared with those in ambulatory heart failure patients awaiting cardiac transplantation. Similarly, the exercise capacity of device patients is better than that of transplant candidates and in the majority of patients is similar to that of patients with mild CHF.
背景
左心室辅助装置（LVADs）常被用作心脏移植的桥梁，也可能作为长期治疗手段。本研究的目的是比较LVAD患者与非卧床心力衰竭患者的运动表现。
方法与结果
对65例充血性心力衰竭（CHF）患者（年龄53±10岁）和20例LVAD患者（年龄49±8岁）进行了运动测试，并测量了血流动力学和呼吸气体指标。LVAD患者的峰值摄氧量显著高于CHF患者（CHF组为12±3；LVAD组为15.9±3.8 mL·kg-1·min-1；P<0.001），无氧阈时的摄氧量也是如此（CHF组为8.1±2.1；LVAD组为12.2±2.9 mL·kg-1·min-1；P<0.001）。静息时，平均动脉血压（CHF组为87±11；LVAD组为94±9 mmHg）和心输出量（CHF组为4±1；LVAD组为4.9±0.9 L/min）升高，而平均肺动脉压（CHF组为28±11；LVAD组为18±4 mmHg）和肺动脉楔压（CHF组为16±10；LVAD组为5±3 mmHg）降低（均P<0.01）。运动峰值时，心率（CHF组为125±24；LVAD组为148±24次/分钟）、血压（CHF组为87±14；LVAD组为96±12 mmHg）和心输出量（CHF组为7.6±2.2；LVAD组为11.2±2.6 L/min）更高（均P<0.01），而LVAD组的平均肺动脉压（CHF组为48±12；LVAD组为30±5 mmHg）和平均肺毛细血管楔压（CHF组为31±11；LVAD组为14±6 mmHg）更低（均P<0.001）。在LVAD患者中，Fick心输出量高于LVAD流量传感器测量值（Fick法为11.6±2.5；LVAD流量传感器测量值为8.1±1.2 L/min；P<0.001）。
结论
与等待心脏移植的非卧床心力衰竭患者相比，使用装置的患者在静息和运动时的血流动力学指标有显著改善。同样，使用装置患者的运动能力优于移植候选者，且在大多数患者中与轻度CHF患者相似。
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