Abstract
Background
Previous work has shown sex-related differences in cardiopulmonary responses in patients
with heart failure (HF); however, sex differences following heart transplant (HTx)
have not been examined. Thus, we hypothesized women would demonstrate lower peak oxygen
uptake (VO2peak) but similar ventilatory efficiency (VE/VCO2 slope) compared with men prior to HTx. Furthermore, we hypothesized that, following
HTx, women would exhibit greater improvements in VO2peak and VE/VCO2 slope compared with men.
Methods
HTx patients with cardiopulmonary exercise testing (CPET) between 2007 and 2016 were
included. Pre-HTx CPET occurred within 24 months pre-HTx with post-HTx CPET within
12 months following HTx. VO2peak was measured via standard protocol. VE/VCO2 slope was calculated using rest-peak ventilation (VE) and carbon dioxide production (VCO2).
Results
Eighty-eight patients (Men [M]: n = 63, age: 55 ± 12 years; Women [W]: n = 25, age:
47 ± 11 years) were assessed. Pre-HTx VO2peak (M: 13.9 ± 5.0 vs W: 11.6 ± 3.9 mL/kg/min, P = 0.17) and VE/VCO2 slope (M: 42 ± 12 vs W: 46 ± 18, P = 0.53) were not different between sexes. Overall, VO2peak (Pre: 13.3 ± 4.8 vs Post: 18.4 ± 4.8 mL/kg/min, P < 0.01) and VE/VCO2 slope (Pre: 43 ± 14 vs Post: 37 ± 6, P = 0.02) improved following HTx. Post-VO2peak (M: 19.0 ± 4.8 vs W: 16.8 ± 4.5 mL/kg/min, P = 0.24) and VE/VCO2 slope (M: 37 ± 6 vs W: 37 ± 7, P = 0.99) and delta VO2peak (M: 5.0 ± 4.8 vs W: 5.3 ± 4.9 mL/kg/min, P = 0.85) and VE/VCO2 slope (M: –5 ± 11 vs W: –9 ± 17, P = 0.29) were not different between sexes.
Conclusions
These data demonstrate that cardiopulmonary improvements following HTx patients occur
for both sexes. Importantly, women show similar significant functional improvements
following HTx compared with men.
Résumé
Contexte
Des travaux antérieurs ont montré des différences liées au sexe dans les réponses
cardiopulmonaires chez les patients atteints d’insuffisance cardiaque. Cependant,
les différences liées au sexe après une transplantation cardiaque (TC) n’ont pas été
examinées. Nous avons donc émis l’hypothèse que les femmes, par rapport aux hommes
ayant subi une TC, présenteraient une consommation maximale d’oxygène (VO2 max) plus faible, mais une efficacité respiratoire (pente VE/VCO2) comparable. Nous avons aussi émis l’hypothèse que les femmes, après avoir subi une
TC, présenteraient des améliorations de la VO2 max et de la pente VE/VCO2 plus importantes que les hommes.
Méthodologie
Les patients qui ont subi une TC qui ont été soumis à une épreuve d’effort cardiopulmonaire
(EECP) entre 2007 et 2016 ont été inclus. L’EECP réalisée avant la TC s’est déroulée
dans les 24 mois précédant la TC, tandis que l’EECP réalisée après la TC s’est déroulée
dans les 12 mois suivant la TC. La VO2 max a été mesurée selon un protocole standard. La pente VE/VCO2 a été calculée à partir de la ventilation (VE) de repos par rapport à la ventilation
(VE) maximale, et de la production de gaz carbonique (VCO2).
Résultats
Quatre-vingt-huit patients (Hommes [H] : n = 63, âge : 55 ± 12 ans; Femmes [F] : n =
25, âge : 47 ± 11 ans) ont été évalués. La VO2 max mesurée avant la TC (H : 13,9 ± 5,0 vs F : 11,6 ± 3,9 ml/kg/min, p = 0,17) de même que la pente VE/VCO2 (H : 42 ± 12 vs F : 46 ± 18, p = 0,53) ne présentaient pas de différences entre les sexes. Globalement, la VO2 max (mesurée avant la TC : 13,3 ± 4,8 vs après la TC : 18,4 ± 4,8 ml/kg/min, p < 0,01) de même que la pente VE/VCO2 (mesurée avant la TC : 43 ± 14 vs après la TC : 37 ± 6, p = 0,02) se sont améliorées après la TC. La VO2 max mesurée après la TC (H : 19,0 ± 4,8 vs F : 16,8 ± 4,5 ml/kg/min, p = 0,24) et la pente VE/VCO2 (H : 37 ± 6 vs F : 37 ± 7, p = 0,99), de même que les valeurs delta de la VO2 max (H : 5,0 ± 4,8 vs F : 5,3 ± 4,9 ml/kg/min, p = 0,85) et de la pente VE/VCO2 (H : -5 ± 11 vs F : -9 ± 17, p = 0,29) n’étaient pas différentes entre les sexes.
Conclusions
Ces données montrent que la santé cardiopulmonaire s’améliore chez les deux sexes
après une transplantation cardiaque. Fait important, on constate, chez les femmes,
des améliorations fonctionnelles après une transplantation cardiaque aussi importantes
que chez les hommes.
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Article info
Publication history
Published online: May 24, 2019
Accepted:
May 21,
2019
Received:
April 4,
2019
Footnotes
See page 58 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
