Severe left ventricular hypertrophy 1 year after transplant predicts mortality in cardiac transplant recipients
Severe left ventricular hypertrophy 1 year after transplant predicts mortality in cardiac transplant recipients
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DOI：
10.1016/j.healun.2006.11.003
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发表时间：
2007-02-01
影响因子：
8.9
通讯作者：
Pereira, Naveen
中科院分区：
文献类型：
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作者：
Goodroe, Randy;Bonnema, D. Dirk;Pereira, Naveen
背景：左心室肥厚（LVH）是已知的原发性高血压患者发病率和死亡率的预测因子。心脏移植受者LVH的患病率和意义尚不清楚。方法：141例连续患者在心脏移植后1年进行经胸超声心动图检查作为常规方案的一部分。使用心脏移植研究数据库中的患者记录和中心特定数据收集人口统计学和超声心动图数据，并对其进行分析，以确定移植后1年LVH的患病率和预测因素。根据左心室质量（LVM）将患者分为三组：正常（LVM < 150 g）；轻中度LVH (LVM 150 ~ 250 g)；重度LVH （LVM > 250 g）。结果：LVH在心脏移植后1年很常见，在83%的心脏移植受者中存在。重度LVH的单因素预测因子为体重指数升高（p < 0.01）、移植前糖尿病（p = 0.02）和移植前高血压（p = 0.01）。多因素分析显示，移植前高血压是严重LVH的唯一独立预测因子（危险比[HR] 2.3, 95%可信区间[CI] 1.1 ~ 5.4,p = 0.05）。与LVM正常和轻、中度LVH患者相比，重度LVH心脏移植受者的生存率显著降低（P = 0.03）。在调整了年龄、种族、性别、移植前高血压和糖尿病等因素的多因素分析后，严重LVH仍然是死亡率的一个强有力的独立预测因子（HR 3.6, 95% CI 1.0 ~ 12.1, P = 0.04）。结论：LVH在心脏移植后1年很常见，是死亡率增加的一个强有力的独立预测因子。移植前高血压是心脏移植后1年出现严重LVH的独立预测因子。
Background: Left ventricular hypertrophy (LVH) is a known predictor of morbidity and mortality in patients with essential hypertension. The prevalence and significance of LVH in heart transplant recipients is unknown.Methods: Transthoracic echocardiograms were performed as part of a routine protocol I year after heart transplantation in 141 consecutive patients. Demographic and echocardiographic data were collected using patients' records and center-specific data from the Cardiac Transplant Research Database and analyzed to determine the prevalence and predictors of LVH at 1 year posttransplantation. Patients were divided into three groups based on left ventricular mass (LVM): normal (LVM < 150 g); mild-moderate LVH (LVM 150 to 250 g); and severe LVH (LVM > 250 g).Results: LVH was common at 1 year after heart transplantation, present in 83% of heart transplant recipients. Univariate predictors of severe LVH were increased body mass index (p < 0.01), pre-transplant diabetes mellitus (p = 0.02) and pre-transplant hypertension (p = 0.01). By multivariate analysis, pre-transplant hypertension was the only independent predictor of severe LVH (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.1 to 5.4,p = 0.05). Heart transplant recipients with severe LVH had significantly decreased survival, as compared to patients with normal LVM and mild-moderate LVH (P = 0.03). After multivaniate analysis adjusting for age, race, gender, pre-transplant hypertension and diabetes, severe LVH remained a strong, independent predictor of mortality (HR 3.6, 95% CI 1.0 to 12.1, P = 0.04).Conclusions: LVH is common at 1 year after heart transplantation and is a strong, independent predictor of increased mortality. Hypertension before transplantation is an independent predictor of the presence of severe LVH at 1 year after heart transplantation.