与心肌病患者相比，先天性心脏病患者在接受小儿心脏移植手术后对运动的顺时针反应减弱

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-09-13 DOI:10.1111/petr.14856

Sebastian Otto‐Meyer, Alan P. Wang, Garett J. Griffith, Katheryn Gambetta, Kendra Ward

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引用次数: 0

摘要

背景小儿心脏移植的两个常见适应症是先天性心脏病和心肌病。先前的研究表明，心脏移植适应症不同，心肺运动测试结果的时序性也不同。我们的目的是确定移植前胸骨切开术的次数是否与运动测试期间心率反应的差异有关。方法对本机构 2004 年至 2022 年期间的小儿心脏移植数据进行了回顾性分析。结果CHD患者（n = 40）与CM患者（n = 53）在移植前胸骨切开的平均次数上存在差异（2.4 ± 1.8 vs. 0.5 ± 0.9，p < 0.001）。超声心动图功能和导管血流动力学无明显差异。在心肺运动测试表现方面，先天性心脏病组的静息心率显著较高（91.8 ± 11.2 vs. 86.4 ± 10.2 bpm，p = 0.019），达到的年龄预测最大心率百分比较低（78.3 ± 8.5% vs. 83.2 ± 11.4%, p = 0.032），心率储备较低（68.6 ± 19.8 vs. 84.4 ± 24.0 bpm, p = 0.001），尽管年龄和平均移植时间相似。回归分析证实，移植前胸骨切开术的次数是预测心率指标的主要因素。两组患者的胸骨切开次数差异很大，这可能支持了一种假设，即之前的手术破坏了心脏神经支配，可能会导致移植后对运动的时向反应减弱。

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Chronotropic Response to Exercise is Decreased in Patients With Congenital Heart Disease Compared to Cardiomyopathy Following Pediatric Heart Transplantation

BackgroundTwo common indications for pediatric heart transplantation are congenital heart disease and cardiomyopathy. Prior studies suggest differences in chronotropy on cardiopulmonary exercise testing outcomes depending on indication for heart transplantation. We aimed to determine whether the number of pretransplant sternotomies is associated with differences in heart rate response during exercise testing.MethodsA retrospective analysis of our institutional pediatric heart transplant data between 2004 and 2022 was performed. Patients were categorized by indication for transplantation into a cardiomyopathy (CM) group if they had a congenital or acquired cardiomyopathy or a congenital heart disease (CHD) group including all other forms of congenital cardiac anatomic abnormalities.ResultsCHD patients (n = 40) differed from CM patients (n = 53) by mean number of sternotomies prior to transplant (2.4 ± 1.8 vs. 0.5 ± 0.9, p < 0.001). There were no significant differences in echocardiographic function or catheterization hemodynamics. In cardiopulmonary exercise testing performance, the congenital heart disease group had a significantly higher resting heart rate (91.8 ± 11.2 vs. 86.4 ± 10.2 bpm, p = 0.019), lower percent predicted age‐predicted maximal heart rate achieved (78.3 ± 8.5% vs. 83.2 ± 11.4%, p = 0.032), and lower heart rate reserve (68.6 ± 19.8 vs. 84.4 ± 24.0 bpm, p = 0.001) despite a similar age and average time from transplantation. Regression analysis confirmed number of pretransplant sternotomies as a main predictor of heart rate metrics.ConclusionsThere is greater chronotropic incompetence in patients who underwent transplantation due to congenital heart disease compared to cardiomyopathy. The groups differ significantly by number of sternotomies, potentially supporting the hypothesis that prior surgical disruption of cardiac innervation may cause decreased chronotropic response to exercise following transplantation.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.