Spleen size improvement in advanced heart failure patients using a left ventricular assist device
Spleen size improvement in advanced heart failure patients using a left ventricular assist device
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DOI：
10.1111/aor.13658
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发表时间：
2020-02-24
影响因子：
2.4
通讯作者：
Murohara, Toyoaki
中科院分区：
文献类型：
--
作者：
Hiraiwa, Hiroaki;Okumura, Takahiro;Murohara, Toyoaki
脾脏是人体重要的血液储备器官，其血液储备量约占血液总量的20%~ 30%。低血容量性休克患者脾脏收缩，脾脏体积缩小。然而，在需要左心室辅助装置（LVAD）支持的晚期心力衰竭（HF）患者中，脾脏体积的变化以及脾脏大小与血流动力学参数之间的相关性尚不清楚。本研究旨在探讨晚期心力衰竭患者左心室辅助装置植入前后脾脏大小的变化及其与血流动力学参数的关系。我们招募了20名接受LVAD支持的晚期HF患者。所有患者在LVAD植入前后均行右心导管检查和计算机断层扫描。通过计算机断层扫描容积法测量脾脏大小。我们排除了LVAD植入前平均右心房压（RAP）2.2 L/min/m2的患者。脾体积从LVAD植入前的160.6 +/- 46.9 mL显著增加至LVAD植入后的224.6 +/- 73.5 mL（P <0.001）。LVAD植入前，脾脏体积与全身血管阻力（SVR）呈显著负相关。然而，LVAD植入后，尽管脾脏体积与SVR之间没有显著相关性，但脾脏体积与心脏指数、RAP和肺毛细血管楔压之间存在显著相关性。此外，1例患者因泵血栓形成导致LVAD失效而发生HF再恶化。在该病例中，LVAD植入前脾脏体积为212 mL，LVAD植入后增加至418 mL，但LVAD失败后降至227 mL。在LVAD支持的晚期HF患者中，脾脏大小可能会根据血流动力学而变化，反映交感神经活动和全身容量状态。
The spleen has been recognized as an important organ that holds a reserve of 20% to 30% of the total blood volume. Spleen contraction and splenic volume reduction occur in patients with hypovolemic shock. However, the change in the spleen volume and the association between spleen size and hemodynamic parameters remain unclear in patients with advanced heart failure (HF) who need left ventricular assist device (LVAD) support. This study was performed to investigate the change in spleen size and the relationship between spleen size and hemodynamic parameters before and after LVAD implantation in patients with advanced HF. We enrolled 20 patients with advanced HF on LVAD support. All patients underwent right heart catheterization and computed tomography before and after LVAD implantation. The spleen size was measured by computed tomography volumetry. We excluded patients with a mean right atrial pressure (RAP) of 2.2 L/min/m(2) before LVAD implantation. The splenic volume significantly increased from 160.6 +/- 46.9 mL before LVAD implantation to 224.6 +/- 73.5 mL after LVAD implantation (P < .001). Before LVAD implantation, there was a significant negative correlation between spleen volume and systemic vascular resistance (SVR). After LVAD implantation, however, there were significant correlations between spleen volume and the cardiac index, RAP, and pulmonary capillary wedge pressure despite the absence of a significant correlation between spleen volume and SVR. Furthermore, one patient developed reworsening HF because of LVAD failure due to pump thrombosis. In this case, the splenic volume was 212 mL before LVAD implantation and increased to 418 mL after LVAD implantation, although it decreased to 227 mL after LVAD failure. The spleen size may change depending on hemodynamics in patients with advanced HF with LVAD support, reflecting sympathetic nerve activity and the systemic volume status.