Changes in cardiopulmonary exercise testing parameters following continuous flow left ventricular assist device implantation and heart transplantation.

Changes in cardiopulmonary exercise testing parameters following continuous flow left ventricular assist device implantation and heart transplantation.
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DOI:
10.1016/j.cardfail.2014.05.008
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发表时间:
2014-08
影响因子:
6
通讯作者:
Pereira, Naveen L.
Pereira, Naveen L.
中科院分区:
医学2区
文献类型:
--
作者:
Dunlay, Shannon M.;Allison, Thomas G.;Pereira, Naveen L.

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心输出量受损导致的运动耐量降低是左心室辅助装置(LVAD)植入的重要标准。然而,人们对LVAD后运动能力的变化以及与接受心脏移植的患者相比的变化知之甚少。我们比较了2007-2012年在明尼苏达州罗切斯特的马约诊所接受HeartMate II LVAD植入术(n=25)和心脏移植术(n=74)的患者术前和术后进行的心肺运动试验的变化。术前,接受LVAD和移植的患者运动时间明显缩短(平均分别为5.1分钟[45%预测值]和5.0分钟[44%预测值]),峰值VO 2较低(平均11.5 ml/kg/min [43%预测值]和11.9 mL/kg/min [38%预测值]),呼吸性气体交换异常(VE/VCO 2最低值39.4和37.4)。LVAD和移植后,运动时间(平均Δ +1.2 vs. 1.7分钟,p=0.27)和VE/VCO 2最低值(平均Δ −3.7 vs. −4.2,p=0.74)的改善相似。然而,峰值VO 2在移植后增加,但在LVAD后没有变化(平均值分别为Δ +5.4 vs. +0.9 mL/kg/min,p<0.001)。大多数患者(72%)在LVAD后的峰值VO 2 <14 mL/kg/min。虽然在LVAD和心脏移植后观察到运动能力和气体交换的改善,但LVAD后峰值VO 2并没有改善,并且在大多数患者中仍然显着异常。
Reduced exercise tolerance from impaired cardiac output is an important criterion for left ventricular assist device (LVAD) implantation. However, little is known about how exercise capacity changes following LVAD, and how changes compare with patients undergoing heart transplant. We compared changes in cardiopulmonary exercise testing performed pre- and post-operatively in patients who underwent HeartMate II LVAD implantation (n=25) and heart transplantation (n=74) at the Mayo Clinic in Rochester, Minnesota from 2007–2012. Pre-operatively, patients undergoing LVAD and transplant had markedly reduced exercise time (mean 5.1 minutes [45% predicted] and 5.0 minutes [44% predicted], respectively), low peak VO2 (mean 11.5 ml/kg/min [43% predicted] and 11.9 mL/kg/min [38% predicted]), and abnormal ventilatory gas exchange (VE/VCO2 nadir 39.4 and 37.4). Following LVAD and transplant, there were similar improvements in exercise time (mean Δ +1.2 vs. 1.7 minutes, respectively, p=0.27) and VE/VCO2 nadir (mean Δ −3.7 vs. −4.2, p=0.74). However, peak VO2 increased post-transplant but did not change post-LVAD (mean Δ +5.4 vs. +0.9 mL/kg/min, respectively, p<0.001). Most patients (72%) had a peak VO2<14 mL/kg/min post-LVAD. While improvements in exercise capacity and gas exchange are seen following LVAD and heart transplant, peak VO2 doesn’t improve post-LVAD and remains markedly abnormal in most patients.
心脏同种异体肥大与心脏移植后运动耐受性受损有关。
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Raichlin E;Al-Omari MA;Hayes CL;Edwards BS;Frantz RP;Boilson BA;Clavell AL;Rodeheffer RJ;Schirger JA;Kushwaha SS;Allison TG;Pereira NL
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