Fontan姑息治疗成人的有氧能力:疾病特异性参考值及其与预后的关系

IF 7.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Heart Failure Pub Date : 2024-12-09 DOI:10.1161/CIRCHEARTFAILURE.124.011981
Alexander C Egbe, Ahmed E Ali, William R Miranda, Heidi M Connolly, Barry A Borlaug
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引用次数: 0

摘要

背景:由于心脏、肺和骨骼肌功能受损,接受Fontan姑息治疗的患者有氧能力降低。然而,该人群的有氧能力评估仍然依赖于与无心血管疾病的人进行比较,而不是与其他Fontan患者的预期有氧能力进行比较。本研究的目的是确定Fontan姑息治疗成人的预期有氧能力。方法:根据预测的峰值耗氧量(VO2),将2003-2023年在梅奥诊所接受心肺运动试验的Fontan缓和患者分为四分位数。我们评估了预测峰值VO2的相关性以及预测峰值VO2四分位数与心血管结局(死亡/移植)之间的关系。结果:323例患者(年龄29±9岁;177[55%]男性),VO2峰值中位数为19.1 (15.2-23.9)mL/kg / min,这对应于预测VO2峰值为51%(范围,19-88;四分位数范围,41-62)。多变量调整后,预测VO2峰值的相关因素为体重指数(β±SE, -2.61±0.95;体重指数每增加5 kg/m2,预测VO2峰值降低2.61%;P=0.009),全身饱和度(β±SE, 3.65±0.85;氧饱和度每增加5%,预测峰值VO2增加3.65%;每增加1毫米汞柱丰滩压力P2;P2四分位数到下一个低四分位数(校正风险比,1.47 [95% CI, 1.09-2.05];P = 0.01)。结论:当前研究的结果将有助于校准对Fontan姑息治疗成人运动试验数据的解释,并改善该人群的风险分层。它还强调需要维持正常的Fontan血流动力学和体重,这是有氧能力的重要决定因素。
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Aerobic Capacity of Adults With Fontan Palliation: Disease-Specific Reference Values and Relationship to Outcomes.

Background: Patients with Fontan palliation have reduced aerobic capacity because of impaired cardiac, pulmonary, and skeletal muscle function. However, the assessment of aerobic capacity in this population still relies on comparisons with people without cardiovascular disease rather than comparison with the expected aerobic capacity of other Fontan patients. The purpose of this study was to determine the expected aerobic capacity of adults with Fontan palliation.

Methods: Adults with Fontan palliation who underwent a cardiopulmonary exercise test at Mayo Clinic (2003-2023) were stratified into quartiles based on the predicted peak oxygen consumption (VO2). We assessed the correlates of predicted peak VO2 and the relationship between predicted peak VO2 quartiles and cardiovascular outcomes (death/transplant).

Results: Of 323 patients (age, 29±9 years; 177 [55%] men), the median peak VO2 was 19.1 (15.2-23.9) mL/kg per minute, and this corresponds to a predicted peak VO2 of 51% (range, 19-88; interquartile range, 41-62). After multivariable adjustments, the correlates of predicted peak VO2 were body mass index (β±SE, -2.61±0.95; 2.61% decrease in predicted peak VO2 per 5 kg/m2 increase in body mass index; P=0.009), systemic saturation (β±SE, 3.65±0.85; 3.65% increase in predicted peak VO2 per 5% increase in oxygen saturation; P<0.001), and Fontan pressure (β±SE, -1.24±0.22; 1.24% decrease in predicted peak VO2 per 1 mm Hg increase in Fontan pressures; P<0.001). There was a 47% increase in the risk for death/transplant from a higher predicted peak VO2 quartile to the next lower quartile (adjusted hazard ratio, 1.47 [95% CI, 1.09-2.05]; P=0.01).

Conclusions: The results of the current study would help calibrate the interpretation of exercise test data in adults with Fontan palliation and improve risk stratification in this population. It also underscores the need to maintain normal Fontan hemodynamics and body weight, which are important determinants of aerobic capacity.

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来源期刊
Circulation: Heart Failure
Circulation: Heart Failure 医学-心血管系统
CiteScore
12.90
自引率
3.10%
发文量
271
审稿时长
6-12 weeks
期刊介绍: Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.
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