Hemodynamic exercise testing - A valuable tool in the selection of cardiac transplantation candidates
Hemodynamic exercise testing - A valuable tool in the selection of cardiac transplantation candidates
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DOI：
10.1161/01.cir.94.12.3176
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发表时间：
1996-12-15
期刊：
影响因子：
37.8
通讯作者：
Wilson, JR
中科院分区：
文献类型：
--
作者：
Chomsky, DB;Lang, CC;Wilson, JR
背景 峰值运动耗氧量（V over dot O-2）是峰值运动心输出量 (CO) 的无创指标，广泛用于选择心脏移植候选者。然而，峰值运动 V 超过点 O-2 可能会受到非心脏因素（例如体能失调、动机或身体成分）的影响，并可能产生误导性的预后信息。直接测量 CO 对运动的反应可以避免这个问题，并更准确地预测预后。 方法和结果 对 185 名转诊接受心脏移植的慢性心力衰竭患者进行最大跑步机运动的血流动力学和通气反应测量（平均左心室射血分数，22+/-7%；平均峰值 V 超过点 O-2. 12.9+/-3.0 mL . min(-1) . kg(-1)。 83 例患者中，O-2 点 V 降低 通过单变量分析，CO 反应正常的患者比 CO 反应降低的患者 (72%) 具有更高的 1 年生存率 (95%) (P14 mL . min(-1) . kg(-1) (88%) 与 O-2 点 V 小于或等于 14 mL . min(-1) . kg(-1) 的患者没有差异。 (79%) (P=NS) 然而，峰值 V 超过点 O-2 小于或等于 10 mL·kg(-1) (52%) 的患者比峰值 V 超过点 O2 (-1) (89%) P 的患者更差。
Background Peak exercise oxygen consumption (V over dot O-2), a noninvasive index of peak exercise cardiac output (CO), is widely used to select candidates for heart transplantation. However, peak exercise V over dot O-2 can be influenced by noncardiac factors such as deconditioning, motivation, or body composition and may yield misleading prognostic information. Direct measurement of the CO response to exercise may avoid this problem and more accurately predict prognosis.Methods and Results Hemodynamic and ventilatory responses to maximal treadmill exercise were measured in 185 ambulatory patients with chronic heart failure who had been referred for cardiac transplantation (mean left ventricular ejection fraction, 22+/-7%; mean peak V over dot O-2. 12.9+/-3.0 mL . min(-1) . kg(-1). CO response to exercise was normal in 83 patients and reduced in V over dot O-2. By univariate analysis, patients with normal CO responses had a better 1-year survival rate (95%) than did those with reduced CO responses (72%) (P14 mL . min(-1) . kg(-1) (88%) was not different from that of patients with V over dot O-2 of less than or equal to 14 mL . min(-1) . kg(-1) (79%) (P=NS). However, survival was worse in patients with peak V over dot O-2 of less than or equal to 10 mL . min(-1) . kg(-1) (52%) versus those with peak V over dot O2 >10 mL . min(-1) . kg(-1) (89%) P