Abstract:
Metabolic Syndrome (MetS), a multifactorial condition that increases the risk of cardio-vascular events, is frequent in Heart-transplant (HTx) candidates and worsens with immunosuppressive therapy. The aim of the study was to analyze the impact of MetS on long-term outcome of HTx patients. Since 2007, 349 HTx patients were enrolled. MetS was diagnosed if patients met revised NCEP-ATP III criteria before HTx, at 1, 5 and 10 years of follow-up. MetS was present in 35% of patients pre-HTx and 47% at 1 year follow-up. Five-year survival in patients with both pre-HTx (65% vs. 78%, p < 0.01) and 1 year follow-up MetS (78% vs 89%, p < 0.01) was worst. At the univariate analysis, risk factors for mortality were pre-HTx MetS (HR 1.86, p < 0.01), hypertension (HR 2.46, p < 0.01), hypertriglyceridemia (HR 1.50, p=0.03), chronic renal failure (HR 2.95, p < 0.01), MetS and diabetes at 1 year follow-up (HR 2.00, p < 0.01; HR 2.02, p < 0.01, respectively). MetS at 1 year follow-up determined a higher risk to develop Coronary allograft vasculopathy at 5 and 10 year follow-up (25% vs 14% and 44% vs 25%, p < 0.01). MetS is an important risk factor for both mortality and morbidity post-HTx, suggesting the need for a strict monitoring of metabolic disorders with a careful nutritional follow-up in HTx patients.
摘要:
代谢综合征(MetS),增加心血管事件风险的多因素条件,在心脏移植(HTx)候选人中经常发生,并且在免疫抑制疗法中恶化。该研究的目的是分析MetS对HTx患者长期预后的影响。自2007年以来,纳入了349例HTx患者。如果患者在HTx之前符合修订的NCEP-ATPIII标准,则诊断为MetS,在1年,5年和10年的随访。MetS在HTx前的患者中有35%存在,在1年随访时的患者中有47%存在。两种HTx前患者的五年生存率(65%与78%,p<0.01)和1年随访MetS(78%vs89%,p<0.01)是最差的。在单变量分析中,死亡的危险因素是HTx之前的MetS(HR1.86,p<0.01),高血压(HR2.46,p<0.01),高甘油三酯血症(HR1.50,p=0.03),慢性肾功能衰竭(HR2.95,p<0.01),1年随访时MetS与糖尿病(分别为HR2.00,p<0.01;HR2.02,p<0.01)。在1年随访时,MetS确定在5年和10年随访时发生冠状动脉移植血管病变的风险更高(25%vs14%和44%vs25%,p<0.01)。MetS是HTx后死亡率和发病率的重要危险因素,提示需要对HTx患者进行严格的营养随访,并对代谢紊乱进行严格的监测。