通过心肺运动试验初步探索左心室辅助装置对终末期心力衰竭患者术后早期活动耐量的影响

Initially exploration of the effect of left ventricular assist device on early postoperative activity tolerance in patients with end-stage heart failure by cardiopulmonary exercise test

目的通过心肺运动试验(cardiopulmonary exercise test,CPET)对终末期心力衰竭患者左心室辅助(left ventricular assist device,LVAD)术后运动能力恢复的情况进行初步探索。方法回顾性分析2021年10月至2022年10月,于阜外华中心血管医院接受LVAD植入术的11例终末期心力衰竭患者,这部分患者术后早期进行心肺运动试验检查并收集相关参数进行分析。结果2021年10月至2022年10月完成的11例LVAD患者中,男性为9例占比81.8%,平均年龄为42岁;病因方面主要为扩张型心肌病7例和心肌致密化不全2例,占比81.8%;4例患者为IABP过渡至LVAD,占比36.4%。术前超声心动图提示这部分患者左心功能较差[左心室射血分数(21.4±4.2)%,左室舒张末径(80.6±10.4)mm],但右心功能处于正常范围[右室前后径(24.8±4.9)mm,三尖瓣环收缩期位移(18.2±4.7)mm]。SWAN-GANZ导管提示肺动脉压力偏高[肺动脉收缩压(41.5±8.7)mmHg,1 mmHg=0.133 kPa]。临床结局方面:1例患者出现围手术期死亡,10例患者存活良好。术后活动耐量方面:术后30 d时活动耐量较差,但术后3个月时活动耐量均有明显改善,其中峰值摄氧量显著提高[(12.9±2.8)ml/(kg·min)比(15.8±1.3)ml/(kg·min),P=0.05],二氧化碳通气有效性斜率显著下降[(42.6±6.3)ml/(kg·min)比(31.7±6.6)ml/(kg·min),P=0.001]。结论LVAD是治疗终末期心力衰竭的有效手段,能够显著改善心衰患者的活动耐量。

Objective To initially explore of left ventricular assisted method(left ventricular assist device,LVAD)on cardiopulmonary exercise test(cardiopulmonary exercise test,CPET).Methods An analysis of 11 patients with end-stage heart failure who underwent LVAD implantation in our hospital from October 2021 to October 2022 was conducted,these patients underwent cardiopulmonary exercise test early after surgery and relevant parameters were collected for analysis.Results Among the 11 LVAD patients from October 2021 to October 2022,9 cases were males(81.8%),and the mean age was 42 years;A total number of 7 cases were dilated cardiomyopathy and 2 cases were myocardial insufficiency,accounting for 36.4%.Preoperative echocardiography suggested that these patients had poor left heart function〔left ventricular ejection fraction(21.4±4.2)%,left ventricular diastolic diameter(80.6±10.4)mm〕,but the right heart function was in the normal range〔right ventricular anterior and posterior diameter(24.8±4.9)mm,(18.2±4.7)mm systolic displacement of the tricuspid annulus〕.The SWAN-GANZ catheter indicated a high pulmonary artery pressure〔pulmonary artery systolic pressure(41.5±8.7)mmHg〕.Clinical outcome:one patient had perioperative death,and 10 patients survived well.Postoperative activity tolerance:The activity tolerance was poor at 30 days after surgery,but activity tolerance improved significantly at 3 months,with peak oxygen uptake〔(12.9±2.8)ml/(kg·min)vs(15.8±1.3)ml/(kg·min),P=0.05〕and the slope of carbon 2 ventilation effectiveness〔(42.6±6.3)ml/(kg·min)vs(31.7±6.6)ml/(kg·min),P=0.001〕.Conclusion LVAD is an effective means to treat end-stage heart failure and can significantly improve the activity tolerance in patients with heart failure.