Relationship between peak cardiac pumping capability and selected exercise-derived prognostic indicators in patients treated with left ventricular assist devices
Relationship between peak cardiac pumping capability and selected exercise-derived prognostic indicators in patients treated with left ventricular assist devices
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DOI：
10.1093/eurjhf/hfr069
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发表时间：
2011-09-01
影响因子：
18.2
通讯作者：
Brodie, David A.
中科院分区：
文献类型：
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作者：
Jakovljevic, Djordje G.;Birks, Emma J.;Brodie, David A.
目的利用运动衍生变量评估慢性心力衰竭患者的功能能力和预后。本研究的目的是评估在接受“Harefield方案”的患者中，以峰值心功率输出为代表的心脏泵送能力与峰值耗氧量、无氧阈值、通气效率斜率和峰值循环功率之间的关系。方法和结果在分级跑步机运动试验中进行血流动力学和气体交换测量。他们对54例患者进行了研究，其中18例植入了左心室辅助装置（lvad）， 16例移植（恢复），20例中重度心力衰竭患者。峰值耗氧量仅外植LVAD组与峰值心功率输出高度相关（r = 0.85, P < 0.01），而植入LVAD组与心力衰竭组无相关性（r = 0.55和0.53,P < 0.05）。无氧阈值与心力衰竭和外植体患者的峰值心功率输出相关性较弱（r = 0.46和0.54,P < 0.05），植入LVAD患者的无氧阈值与峰值心功率输出相关性较弱（r = 0.37, P < 0.05）。移植和外植LVAD患者的峰值心功率输出与循环功率峰值相关（r = 0.82, P < 0.01; r = 0.63, P < 0.01），心力衰竭患者无相关性（r = 0.31, P < 0.05）。lvad外植患者的通气效率斜率与峰值心功率输出仅中度相关（r = -20.52, P < 0.05）。结论运动衍生预后指标反映lvad患者心脏泵血能力的能力有限，因此在解释心脏器官功能时应谨慎使用。
Aim Exercise-derived variables have been used in the assessment of functional capacity and prognosis in patients with chronic heart failure. The aim of this study was to assess the relationship between cardiac pumping capability represented by peak cardiac power output and peak oxygen consumption, anaerobic threshold, ventilatory efficiency slope, and peak circulatory power in patients undergoing the 'Harefield Protocol'.Methods and results Haemodynamic and gas exchange measurements were undertaken during a graded treadmill exercise test. They were performed on 54 patients-18 implanted with left ventricular assist devices (LVADs), 16 explanted (recovered), and 20 moderate-to-severe heart failure patients. Peak oxygen consumption was only highly correlated with peak cardiac power output in explanted LVAD (r = 0.85, P < 0.01), but not in implanted LVAD and heart failure patients (r = 0.55 and 0.53, P < 0.05). The anaerobic threshold was only modestly correlated with peak cardiac power output in heart failure and explanted (r = 0.46 and 0.54, P < 0.05) and weakly in implanted LVAD patients (r = 0.37, P < 0.05). Peak cardiac power output was well correlated with peak circulatory power in LVAD explanted and implanted (r = 0.82, P < 0.01; r = 0.63, P < 0.01) but not in heart failure patients (r = 0.31, P > 0.05). Ventilatory efficiency slope was only moderately correlated with peak cardiac power output in LVAD-explanted patients (r = -20.52, P < 0.05).Conclusion Exercise-derived prognostic indicators demonstrate limited capacity in reflecting cardiac pumping capability in patients treated with LVADs and should therefore be used with caution in interpretation of cardiac organ function.