在使用左心室辅助装置的患者中,重复测量氧气吸收峰值的预后值
William Herrik Nielsen1, Mariusz K Szymanski2, Kiran K Mirza1
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
概括
在左心室辅助装置 (LVAD) 支持的患者中,重复测量氧气吸收峰值 (pVO2) 可以预测死亡率. 维持或改善pVO2表明更好的生存结果,提供有价值的预后信息.
科学领域:
- 心脏病学 心脏病学
- 运动生理学 运动生理学
- 医疗器械 医疗器械
背景情况:
- 氧气吸收峰值 (pVO2) 是心力衰竭患者与左心室辅助器件 (LVAD) 支持的关键死亡率预测因子.
- 之前的PRO-VAD研究已经确定了pVO2的预后意义.
研究的目的:
- 评估 LVAD 患者的连续 pVO2 测量结果的预后值.
- 评估随着时间的推移,pVO2的变化如何影响生存结果.
主要方法:
- 一项PRO-VAD队列的后续研究,涉及152名患者,他们在LVAD植入后大约6个月和12个月接受了两次心肺运动测试 (CPET).
- 在每个CPET中,患者根据低 (≤14毫升/千克/分钟或≤12毫升/千克/分钟,如果耐受β-阻断剂) 或高的pVO2水平进行分组.
- 使用卡普兰-梅尔和考克斯回归模型分析了生存率.
主要成果:
- 观察到0.4毫升/千克/分钟 (p=0.04) 的轻微但显著的pVO2中位数改善.
- 持续高的pVO2与与持续低的pVO2相比,死亡风险降低了5倍 (HR 0.20,p=0.002).
- 从低pVO2向高pVO2的改善也显示出显著的生存益处 (HR 0.21,p=0.02).
结论:
- 重复的pVO2测量在LVAD患者中保持了预后价值.
- 在pVO2的变化提供了额外的见解,以确定患者的优秀的结果.
- 序列pVO2评估可以指导对LVAD患者进一步干预的决策.
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