Cardiac allograft hypertrophy is associated with impaired exercise tolerance after heart transplantation.
Cardiac allograft hypertrophy is associated with impaired exercise tolerance after heart transplantation.
复制标题
心脏同种异体肥大与心脏移植后运动耐受性受损有关。
DOI：
10.1016/j.healun.2011.04.012
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发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
Pereira NL
中科院分区：
文献类型：
--
作者：
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
运动能力是生活质量的一个重要方面，但在心脏移植（HTx）后仍然有限。本研究探讨了心脏移植物重塑对HTx后功能的影响。根据HTx后1年时超声心动图测定的左心室质量和相对室壁厚度，将117名HTx接受者的总队列分为3组：（1）NG -正常几何结构（2）CR -向心性重塑和（3）CH -向心性肥大。所有患者在HTx后5.03±3.08年进行了心脏运动试验。排除急性排斥反应或严重移植血管病变的患者。HTx后1年，30%的患者有CH，55%有CR，15%表现为NG。与NG组相比，CH组通过最大代谢当量（4.62± 1.44 vs.5.52 ±0.96 kcal/kg/h）、标准化峰值VO 2（52±14% vs.63 ±12%）和VE/VCO 2（41±17 vs.34 ±6）测量的运动耐量受损。NG、CR和CH组中峰值VO 2 ≤14 ml/kg/min的比例分别为6%、22%和48%（p=0.01）。与NG患者相比，CH模式与峰值VO 2 ≤14 ml/kg/min的相对风险增加7.4倍相关（95% CI 1.1 - 51.9，p=0.001）。多变量分析后，1年CH模式与标准化峰值VO 2降低（p=0.018）和VE/VCO 2升高（p=0.035）独立相关。在稳定的心脏移植受者中，HTx后一年CH的存在与标准化峰值VO 2降低和缓解反应增加独立相关。CH是HTx后运动能力受损的一种潜在可逆机制，其识别可能具有重要的临床意义。
Exercise performance, an important aspect of quality of life, remains limited after heart transplantation (HTx). This study examines the effect of cardiac allograft remodeling on functional capacity after HTx. The total cohort of 117 HTx recipients based on echocardiographic determination of left ventricle mass and relative wall thickness at 1 year after HTx, was divided into 3 groups: (1) NG - normal geometry (2) CR - concentric remodeling and (3) CH - concentric hypertrophy. Cardiopulmonary exercise testing was performed 5.03±3.08 years after HTx in all patients. Patients with acute rejection or significant graft vasculopathy were excluded. At 1 year after HTx, 30% patients had CH, 55% had CR and 15% demonstrated NG. Exercise tolerance measured by maximum achieved metabolic equivalents (4.62±1.44vs.5.52±0.96 kcal/kg/h), normalized peak VO2 (52±14% vs. 63±12%) and VE/VCO2 (41±17 vs. 34±6) were impaired in the CH group compared to the NG group. A peak VO2≤14 ml/kg/min was found in 6%, 22% and 48% in the NG, CR and CH groups respectively (p=0.01). The CH pattern was associated with a 7.4 – fold increase in relative risk for a peak VO2≤14 ml/kg/min as compared to NG patients (95% CI 1.1 – 51.9, p=0.001). After multivariable analysis, a 1-year CH pattern was independently associated with reduced normalized peak VO2 (p=0.018) and an elevated VE/VCO2 (p=0.035). The presence of CH one year after HTx is independently associated with decreased normalized peak VO2 and increased ventilatory response in stable heart transplant recipients. The identification of CH, a potentially reversible mechanism of impairment in exercise capacity after HTx, could have important clinical implications.
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影响因子：
37.8
作者：
Devereux, RB;Dahlöf, B;Wachtell, K
通讯作者：
Wachtell, K
DOI：
10.1016/s0735-1097(98)00227-7
发表时间：
1998-08-01
影响因子：
24
作者：
Lampert, E;Mettauer, B;Lonsdorfer, J
通讯作者：
Lonsdorfer, J
影响因子：
8.9
作者：
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通讯作者：
Pereira, Naveen
影响因子：
37.8
作者：
Biasucci, LM;Liuzzo, G;Maseri, A
通讯作者：
Maseri, A
影响因子：
158.5
作者：
Ojo, AO;Held, PJ;Merion, RM
通讯作者：
Merion, RM