Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation.
Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation.
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DOI：
10.1016/j.healun.2013.03.004
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Bartels MN
中科院分区：
文献类型：
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作者：
Armstrong HF;Schulze PC;Kato TS;Bacchetta M;Thirapatarapong W;Bartels MN
研究表明，肺移植（LTx）前右心室（RV）功能较差的患者术后通气时间和重症监护时间延长，住院死亡风险较高。RV每搏作功指数（RVSWI）计算RV工作负荷和收缩力。我们假设，具有较高RV工作负荷能力的患者（由较高的RVSWI指示）在LTx后会有更好的结局。对2005年至2011年期间在LTx前1年接受右心导管插入术（RHC）的所有LTx患者进行了回顾性记录审查。此外，收集了RHC 1年内的超声心动图和心肺运动试验结果。115例患者的平均RVSWI为9.36 ± 3.59。平均肺动脉压（mPAP）、RVSWI、RV舒张末期直径（RVEDd）、左心房内径（LAD）、呼气末二氧化碳峰值和静息压、每分钟通气量/二氧化碳产生量与LTx后1年死亡率之间存在显著相关性。与我们的假设相反，存活者的RVSWI低于1年内死亡者（8.99 ± 3.38 vs 11.6 ± 4.1，p = 0.026）。住院时间与mPAP、RVSWI、左室射血分数、短轴缩短率、RVEDd、RV面积变化分数、LAD、RV室壁厚度显著相关。重症监护住院时间也与这些变量和体重指数显著相关。RVSWI在不同RV功能组之间存在显著差异，表明RVSWI增加与接受LTx评价的患者的RV结构和功能受损相关。本研究证实了1年死亡率、初始住院时间和重症监护住院时间以及LTx前RVSWI之间的相关性。mPAP升高是LTx患者结局的已知风险。我们的研究结果支持了这一事实，并且还显示随着RVSWI升高，死亡率增加，证明了RV功能在LTx前患者风险评估中的价值。
Studies have shown that patients with poor pre-lung transplant (LTx) right ventricular (RV) function have prolonged post-operative ventilation time and intensive care stay as well as a higher risk of in-hospital death. RV stroke work index (RVSWI) calculates RV workload and contractility. We hypothesized that patients with higher RV workload capacity, indicated by higher RVSWI, would have better outcomes after LTx. A retrospective record review was performed on all LTx patients between 2005 and 2011 who had right heart catheterizations (RHC) 1-year before LTx. In addition, results for echocardiograms and cardiopulmonary exercise testing within 1-year of RHCs were gathered. Mean RVSWI was 9.36 ± 3.59 for 115 patients. There was a significant relation between mean pulmonary artery pressure (mPAP), RVSWI, RV end-diastolic diameter (RVEDd), left atrial dimension (LAD), peak and resting pressure of end-tidal carbon dioxide, minute ventilation /volume of carbon dioxide production, and 1-year mortality after LTx. Contrary to our hypothesis, those who survived had lower RVSWI than those who died within 1 year (8.99 ± 3.38 vs 11.6 ± 4.1, p = 0.026). Hospital length of stay significantly correlated with mPAP, RVSWI, left ventricular ejection fraction, percentage of fractional shortening, RVEDd, RV fractional area change, LAD, and RV wall thickness in diastole. Intensive care length of stay also significantly correlated with these variables and with body mass index. RVSWI was significantly different between groups of different RV function, indicating that increased RVSWI is associated with impairment of RV structure and function in patients undergoing LTx evaluation. This study demonstrates an association between 1-year mortality, initial hospital and intensive care length of stay, and pre-LTx RVSWI. Increased mPAP is a known risk for outcomes in LTx patients. Our findings support this fact and also show increased mortality with elevation of RVSWI, demonstrating the value of RV function in the assessment of risk for pre-LTx patients.