JAHA:连续流式左心室辅助装置患者的代谢功能障碍和结局

2019-11-29 xiangting MedSci原创

代谢障碍在晚期心衰患者中非常普遍,并在CF‐LVAD植入后得到改善。正常的代谢状态与无心衰再入院的1年生存率明显相关。

代谢障碍在心衰患者中很常见。连续流式左心室辅助装置(CF‐LVADs)可以改善晚期心衰患者的血液动力学和预后;但是,CF‐LVADs对代谢状态的影响尚不清楚。这项研究旨在评估CF‐LVAD植入后代谢状态的变化以及衡量代谢状态与结局的相关性。

获取CF‐LVAD患者的前瞻性数据。在植入前和植入后多个时间点进行代谢评估,包括血红蛋白A1C、游离和总睾丸激素、促甲状腺激素(TSH)和游离T4。TSH水平不升高、血红蛋白A1C和睾丸激素水平正常的患者被定义为代谢状态正常。收集基线特征、血液动力学和结局。

研究了106例患者,其中56例在基线和1-3个月的随访中具有配对数据。植入前,75%的患者存在胰岛素抵抗,86%的男性和39%的女性游离睾丸激素水平低,44%的患者甲状腺功能异常。植入后血红蛋白A1C、游离睾丸激素和TSH明显改善(P均<0.001)。植入后血红蛋白A1C正常的患者(<5.7%)无心衰再入院的1年生存率更高(78%vs 23%;P<0.001)。植入后代谢状态正常的患者无心衰再入院的1年生存率较高(92%vs 54%;P=0.04)。

代谢障碍在晚期心衰患者中非常普遍,并在CF‐LVAD植入后得到改善。正常的代谢状态与无心衰再入院的1年生存率明显相关。

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