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Abstract

OBJECTIVES: The purpose of this study was to examine whether peak oxygen uptake (pVO2) and other cardiopulmonary exercise test (CPET)-derived variables could predict intermediate-term mortality in stable continuous flow LVAD recipients.

BACKGROUND: pVO2 is a cornerstone in the selection of patients for heart transplantation, but the prognostic power of pVO2 obtained in patients treated with a left ventricular assist device (LVAD) is unknown.

METHODS: We collected data for pVO2 and outcomes in adult LVAD recipients in a retrospective, multicenter study and evaluated cutoff values for pVO2 including: 1) values above or below medians; 2) grouping patients in tertiles; and 3) pVO2 ≤14 ml/kg/min if the patient was not treated with beta-blockers (BB) or pVO2 ≤12 ml/kg/min if the patient was taking BB therapy.

RESULTS: Nine centers contributed data from 450 patients. Patients were 53 ± 13 years of age; 78% were male; body mass index was 25 ± 5 kg/m2 with few comorbidities (stroke: 11%; diabetes: 18%; and peripheral artery disease: 4%). The cause of heart failure (HF) was most often nonischemic (66%). Devices included were the HeartMate II and 3 (Abbott); and Heartware ventricular assist devices Jarvik and Duraheart (Medtronic). The index CPET was performed at a median of 189 days (154 days-225 days) after LVAD implantation, and mean pVO2 was 14.1 ± 5 ml/kg/min (47% ± 14% of predicted value). Lower pVO2 values were strongly associated with poorer survival regardless of whether patients were analyzed for absolute pVO2 in ml/kg/min, pVO2 ≤12 BB/14 ml/kg/min, or as a percentage of predicted pVO2 values (P ≤ 0.001 for all). For patients with pVO2 >12 BB/14 and ventilation/carbon dioxide relationship (VE/VCO2) slope <35, the 1-year survival was 100%.

CONCLUSIONS: Even after LVAD implantation, pVO2 has prognostic value, similar to HF patients not supported by mechanical circulatory support devices. (PROgnostic Value of Exercise Capacity Measured as Peak Oxygen Uptake [pVO2] in Recipients of Left Ventricular Assist Devices [PRO-VAD]; NCT04423562).

Original languageEnglish
Pages (from-to)758-767
Number of pages10
JournalJACC. Heart failure
Volume9
Issue number10
Early online date11 Aug 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

© 2021, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.

Funder

Dr Mirza received Danish funding from Skibsreder Per Henriksen, R og hustrus Fond grant 10403/53 and Jascha Fonden grants 6186 and 7724. Dr Gustafsson is supported by research grant NNF20OC006056 from the Novo Nordisk Foundation. Dr Brahmbhatt has received travel support from Abbott, Biotronik; and has received honoraria, travel support, and research funding from Boston Scientific (all outside the submitted work). Dr Hsu has received U.S. National Institutes of Health funding (grant K23-HL146889) (all outside the submitted work). Dr MacGowan is supported by EU Horizon 2020 and United Kingdom National Institute of Health Research. Dr Jakovljevic is supported by EU Horizon 2020 Research and Innovation Programme under grant agreements 777204 and 952603

Keywords

  • excercise
  • maximum oxygen uptake
  • outcome
  • prognosis
  • survival
  • exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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