左心室人工肾脏患者重复峰值摄氧量测量的预后价值

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation Pub Date : 2025-02-01 DOI:10.1016/j.healun.2024.10.003

William Herrik Nielsen MD , Mariusz K. Szymanski MD, PhD , Kiran K. Mirza MD, PhD , Linda W. Van Laake MD, PhD , Thomas Schmidt MA, PhD , Darshan H. Brahmbhatt MB, BChir, MD (Res) , Filio Billia MD, PhD, FRCPC , Steven Hsu MD, FACC , Guy MacGowan MD, FRCPI, FACC , Djordje G. Jakovljevic PhD , Piergiuseppe Agostoni MD, PhD , Filippo Trombara MD , Ulrich P. Jorde MD, PhD , Yogita Rochlani MD , Katrien Vandersmissen MSN , Nils Reiss MD, PhD , Stuart D. Russell MD , Bart Meyns MD, PhD , Finn Gustafsson MD, PhD, DMSC

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引用次数: 0

摘要

背景峰值摄氧量（pVO2）可预测接受左心室辅助装置（LVAD）支持的心衰患者的死亡率。方法这项多中心随访研究纳入了 PRO-VAD 原始队列中进行过两次心肺运动测试 (CPET) 的患者。根据两次 CPET 的 pVO2 水平，将患者分为四组：两次测试均为低水平；第一次测试为低水平，第二次测试为高水平；第一次测试为高水平，第二次测试为低水平；两次测试均为高水平。低 pVO2 定义为≤14 mL/kg/min（或≤12 mL/kg/min，如果能耐受β-受体阻滞剂），而高于这些阈值则被视为高。结果该研究纳入了 152 例在 LVAD 植入后约 6 个月和 12 个月重复 CPET 的患者。队列显示 pVO2 有轻微但显著的改善（中位变化：0.4 mL/kg/min，P = 0.04）。与持续低 pVO2 患者（46 例）相比，持续高 pVO2 患者（76 例）的死亡率降低了五倍（HR 0.20，P = 0.002）。结论pVO2 的测量结果仍可预测 LVAD 患者再次复查时的死亡率，pVO2 的变化在确定持续接受 LVAD 支持的患者是否具有良好预后以及确定需要进一步干预的患者方面具有额外的预后价值。

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Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device

Background

Peak oxygen uptake (pVO₂) predicts mortality in patients with heart failure on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO₂ measurements during long-term follow-up.

Methods

This multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into 4 groups based on pVO₂ levels at the 2 CPETs: low at both tests, low at the first and high at the second test, high at the first and low at the second test, and high at both tests. Low pVO₂ was defined as ≤14 ml/kg/min (or ≤12 ml/kg/min if beta-blocker tolerant), while values above these thresholds were considered high. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis.

Results

The study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO₂ improvement (median change: 0.4 ml/kg/min, p = 0.04). Persistently high pVO₂ (76 patients) was associated with a 5-fold reduction in mortality hazard (hazard ratio [HR] 0.20, p = 0.002), compared with persistently low pVO₂ (46 patients). Improvement from low to high pVO₂ (21 patients) displayed similar benefits (HR 0.21, p = 0.02).

Conclusions

pVO₂ measurements remain predictive of mortality upon reiteration in patients with LVAD, with changes in pVO₂ providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions.

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来源期刊

Journal of Heart and Lung Transplantation 医学-呼吸系统

CiteScore

10.10

自引率

6.70%

发文量

1667

审稿时长

69 days

期刊介绍： The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.