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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2001 December;42(6):705-7

lingua: Inglese

Serum lactates are not predictive of heart failure severity in status I cardiac transplant candidates

Canver C. C.

From the Division of Cardiothoracic Surgery Albany Medical College Albany, New York, USA


Background. Blood lac­tate is an accu­rate pre­dic­tor of out­come in clin­i­cal ­shock syn­drome ­patients. However, its use­ful­ness in stat­us I ­heart trans­plant can­di­dates ­with fail­ing myo­car­di­um is large­ly ­unknown. The pur­pose of ­this ­study was to deter­mine wheth­er ser­um lac­tate lev­els are pre­dic­tive of con­ges­tive ­heart fail­ure sever­ity in car­di­om­yo­path­ic stat­us I car­diac trans­plant can­di­dates.
Methods. Over a 6-­month peri­od, seri­al arte­ri­al ser­um lac­tate lev­els in 30 stat­us I ­heart trans­plant can­di­dates ­were meas­ured. Measured ser­um lac­tate val­ues (­mmol/L) includ­ed the ­initial lac­tate lev­el ­upon admis­sion to the inten­sive ­care ­unit and the lac­tate lev­el at 6-­week inter­vals up to 24-­weeks. Surveillance ­right ­heart cath­et­er­iza­tions ­were ­also per­formed at 6-­week inter­vals to deter­mine pul­mo­nary ­artery pres­sures and car­diac ­index. Baseline meas­ure­ments ­were com­pared ­with the val­ues ­obtained at ­time inter­vals of 6-, 12-, 18-, and 24-­weeks.
Results. All stat­us I ­heart trans­plant can­di­dates ­were admit­ted to the inten­sive ­care ­unit for treat­ment of wors­en­ing ­heart fail­ure ­with intra­ve­nous inotrop­ic ther­a­py. All ­patients had ­severe pul­mo­nary hyper­ten­sion (great­er ­than two-­thirds of system­ic arte­ri­al pres­sure, mmHg) and/or ­severe low car­diac out­put ­state (car­diac ­index ­less ­than 2.0 L/min/M2). Admission lac­tate lev­el was nor­mal in all can­di­dates. Intravenous inotrop­ic ther­a­py ­improved ­patients’ symp­toms and car­di­o­pul­mo­nary hemo­dy­nam­ic derange­ments ­although lac­tate lev­els ­remained with­in the nor­mal ­range ­until the ­time of ­heart trans­plant oper­a­tion or up to 24-­weeks (p=NS).
Conclusions. Blood lac­tate ­remains unaf­fect­ed by wors­en­ing con­ges­tive ­heart fail­ure of car­di­om­yo­pa­thy ­patients and is not pre­dic­tive of ­heart fail­ure sever­ity in stat­us I car­diac trans­plant can­di­dates.

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