Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device

William Herrik Nielsen; Mariusz K Szymanski; Kiran K Mirza; Linda W. Van Laake; Thomas Schmidt; Darshan H Brahmbhatt; Filio Billia; Steven Hsu; Guy MacGowan; Djordje Jakovljevic; Piergiuseppe Agostoni; Filippo Trombara; Ulrich P. Jorde; Yogita Rochlani; Katrien Vandersmissen; Nils Reiss; Stuart D Russell; Bart Meyns; Finn Gustafsson

doi:10.1016/j.healun.2024.10.003

Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device

William Herrik Nielsen
, Mariusz K Szymanski
, Kiran K Mirza
, Linda W. Van Laake
, Thomas Schmidt
, Darshan H Brahmbhatt
, Filio Billia
, Steven Hsu
, Guy MacGowan
, Djordje Jakovljevic
, Piergiuseppe Agostoni
, Filippo Trombara
, Ulrich P. Jorde
, Yogita Rochlani
, Katrien Vandersmissen
, Nils Reiss
, Stuart D Russell
, Bart Meyns
, Finn Gustafsson

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

4 Downloads (Pure)

Abstract

Background: Peak oxygen uptake (pVO₂) predicts mortality in patients with heart failure on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO₂ measurements during long-term follow-up.

Methods: This multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into 4 groups based on pVO₂ levels at the 2 CPETs: low at both tests, low at the first and high at the second test, high at the first and low at the second test, and high at both tests. Low pVO₂ was defined as ≤14 ml/kg/min (or ≤12 ml/kg/min if beta-blocker tolerant), while values above these thresholds were considered high. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis.

Results: The study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO₂ improvement (median change: 0.4 ml/kg/min, p = 0.04). Persistently high pVO₂ (76 patients) was associated with a 5-fold reduction in mortality hazard (hazard ratio [HR] 0.20, p = 0.002), compared with persistently low pVO₂ (46 patients). Improvement from low to high pVO₂ (21 patients) displayed similar benefits (HR 0.21, p = 0.02).

Conclusions: pVO₂ measurements remain predictive of mortality upon reiteration in patients with LVAD, with changes in pVO₂ providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions.

Original language	English
Pages (from-to)	236-245
Number of pages	10
Journal	Journal of Heart and Lung Transplantation
Volume	44
Issue number	2
Early online date	18 Oct 2024
DOIs	https://doi.org/10.1016/j.healun.2024.10.003
Publication status	Published - Feb 2025

Bibliographical note

Publisher Copyright:
© 2024 International Society for the Heart and Lung Transplantation

Funding

Nielsen received funding from the Novo Nordisk Foundation (grant no. 20OC0060561) and support for meeting attendance from Pharmacosmos. Szymanski received honoraria from Chiesi and AstraZeneca, paid to UMC Utrecht. Van Laake is supported by grants from Medtronic and Abbott to UMC Utrecht and has received honoraria from CVOI, Medcon, and Abbott via UMC Utrecht. Schmidt is involved with the German Society of Cardiology and the German Society of Prevention and Rehabilitation of Cardiovascular Diseases and received bicycle ergometers on a free loan from Ergoline GmbH. Brahmbhatt received post-doctoral fellowship funding from Transform HF (Ontario, Canada) and support for meeting attendance from Abbott. Billia received a physician-initiated research grant from Abbott. Hsu is funded by the U.S. National Institutes of Health (grant no. NIH K23HL146889). Jakovljevic is supported by grants from Horizon Europe (STRATIFYHF research project), Horizon2020 (SGABU and SILICOFCM research projects), and Cardinal Health (HRVDISPOSE research project). Agostoni received funding from the European Union \u2013 Next Generation (grant no. PNRR-MAD-2022-12375794), consulting fees from Schiller, honoraria from CPX International, advisory board payments from AstraZeneca, and support for meeting attendance from Societ\u00E0 Italiana di Cardiologica and CPX International. Trombara received travel expenses from EasyNet (Lombardy region). Jorde received consulting fees from Abbott and serves on the ISHLT Research Oversight Committee. Reiss is involved with the German Society of Prevention and Rehabilitation of Cardiovascular Diseases. Russell received consulting fees from Medtronic (ended Jan 2023) and advisory board payments from Abbott. Meyns has an institutional research agreement with Abiomed, Berlin Heart, and RealHeart and received honoraria from Abbott. Gustafsson received consulting fees from Abbott, FineHeart, AdjuCor, Bayer, AstraZeneca, and Pfizer; honoraria from Novartis; advisory board payments from AdjuCor; and serves as an unpaid board member of the Heart Failure Association of the ESC. Authors Mirza, MacGowan, Rochlani, and Vandersmissen have nothing to disclose.

Funders	Funder number
Novo Nordisk Fonden	20OC0060561
Chiesi Farmaceutici
AstraZeneca
Medtronic
Abbott Laboratories
TRANSFORM HF
National Institutes of Health	K23HL146889
Horizon Europe
European Union
CPX International
Schiller

Keywords

left ventricular assist devices
peak oxygen uptake
prognosis
pVO2
repeated cardiopulmonary exercise testing

Access to Document

10.1016/j.healun.2024.10.003

v4_PRO-VAD2_manuscriptAccepted author manuscript, 384 KBLicence: CC BY-NC-ND

Cite this

Nielsen, W. H., Szymanski, M. K., Mirza, K. K., Van Laake, L. W., Schmidt, T., Brahmbhatt, D. H., Billia, F., Hsu, S., MacGowan, G., Jakovljevic, D., Agostoni, P., Trombara, F., Jorde, U. P., Rochlani, Y., Vandersmissen, K., Reiss, N., Russell, S. D., Meyns, B., & Gustafsson, F. (2025). Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device. Journal of Heart and Lung Transplantation, 44(2), 236-245. https://doi.org/10.1016/j.healun.2024.10.003

Nielsen, WH, Szymanski, MK, Mirza, KK, Van Laake, LW, Schmidt, T, Brahmbhatt, DH, Billia, F, Hsu, S, MacGowan, G, Jakovljevic, D, Agostoni, P, Trombara, F, Jorde, UP, Rochlani, Y, Vandersmissen, K, Reiss, N, Russell, SD, Meyns, B & Gustafsson, F 2025, 'Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device', Journal of Heart and Lung Transplantation, vol. 44, no. 2, pp. 236-245. https://doi.org/10.1016/j.healun.2024.10.003

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title = "Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device",

abstract = "Background: Peak oxygen uptake (pVO2) predicts mortality in patients with heart failure on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO2 measurements during long-term follow-up. Methods: This multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into 4 groups based on pVO2 levels at the 2 CPETs: low at both tests, low at the first and high at the second test, high at the first and low at the second test, and high at both tests. Low pVO2 was defined as ≤14 ml/kg/min (or ≤12 ml/kg/min if beta-blocker tolerant), while values above these thresholds were considered high. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis. Results: The study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO2 improvement (median change: 0.4 ml/kg/min, p = 0.04). Persistently high pVO2 (76 patients) was associated with a 5-fold reduction in mortality hazard (hazard ratio [HR] 0.20, p = 0.002), compared with persistently low pVO2 (46 patients). Improvement from low to high pVO2 (21 patients) displayed similar benefits (HR 0.21, p = 0.02). Conclusions: pVO2 measurements remain predictive of mortality upon reiteration in patients with LVAD, with changes in pVO2 providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions. ",

keywords = "left ventricular assist devices, peak oxygen uptake, prognosis, pVO2, repeated cardiopulmonary exercise testing",

author = "Nielsen, \{William Herrik\} and Szymanski, \{Mariusz K\} and Mirza, \{Kiran K\} and \{Van Laake\}, \{Linda W.\} and Thomas Schmidt and Brahmbhatt, \{Darshan H\} and Filio Billia and Steven Hsu and Guy MacGowan and Djordje Jakovljevic and Piergiuseppe Agostoni and Filippo Trombara and Jorde, \{Ulrich P.\} and Yogita Rochlani and Katrien Vandersmissen and Nils Reiss and Russell, \{Stuart D\} and Bart Meyns and Finn Gustafsson",

note = "Publisher Copyright: {\textcopyright} 2024 International Society for the Heart and Lung Transplantation",

year = "2025",

month = feb,

doi = "10.1016/j.healun.2024.10.003",

language = "English",

volume = "44",

pages = "236--245",

journal = "Journal of Heart and Lung Transplantation",

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TY - JOUR

T1 - Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device

AU - Nielsen, William Herrik

AU - Szymanski, Mariusz K

AU - Mirza, Kiran K

AU - Van Laake, Linda W.

AU - Schmidt, Thomas

AU - Brahmbhatt, Darshan H

AU - Billia, Filio

AU - Hsu, Steven

AU - MacGowan, Guy

AU - Jakovljevic, Djordje

AU - Agostoni, Piergiuseppe

AU - Trombara, Filippo

AU - Jorde, Ulrich P.

AU - Rochlani, Yogita

AU - Vandersmissen, Katrien

AU - Reiss, Nils

AU - Russell, Stuart D

AU - Meyns, Bart

AU - Gustafsson, Finn

PY - 2025/2

Y1 - 2025/2

N2 - Background: Peak oxygen uptake (pVO2) predicts mortality in patients with heart failure on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO2 measurements during long-term follow-up. Methods: This multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into 4 groups based on pVO2 levels at the 2 CPETs: low at both tests, low at the first and high at the second test, high at the first and low at the second test, and high at both tests. Low pVO2 was defined as ≤14 ml/kg/min (or ≤12 ml/kg/min if beta-blocker tolerant), while values above these thresholds were considered high. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis. Results: The study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO2 improvement (median change: 0.4 ml/kg/min, p = 0.04). Persistently high pVO2 (76 patients) was associated with a 5-fold reduction in mortality hazard (hazard ratio [HR] 0.20, p = 0.002), compared with persistently low pVO2 (46 patients). Improvement from low to high pVO2 (21 patients) displayed similar benefits (HR 0.21, p = 0.02). Conclusions: pVO2 measurements remain predictive of mortality upon reiteration in patients with LVAD, with changes in pVO2 providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions.

AB - Background: Peak oxygen uptake (pVO2) predicts mortality in patients with heart failure on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO2 measurements during long-term follow-up. Methods: This multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into 4 groups based on pVO2 levels at the 2 CPETs: low at both tests, low at the first and high at the second test, high at the first and low at the second test, and high at both tests. Low pVO2 was defined as ≤14 ml/kg/min (or ≤12 ml/kg/min if beta-blocker tolerant), while values above these thresholds were considered high. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis. Results: The study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO2 improvement (median change: 0.4 ml/kg/min, p = 0.04). Persistently high pVO2 (76 patients) was associated with a 5-fold reduction in mortality hazard (hazard ratio [HR] 0.20, p = 0.002), compared with persistently low pVO2 (46 patients). Improvement from low to high pVO2 (21 patients) displayed similar benefits (HR 0.21, p = 0.02). Conclusions: pVO2 measurements remain predictive of mortality upon reiteration in patients with LVAD, with changes in pVO2 providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions.

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DO - 10.1016/j.healun.2024.10.003

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SN - 1053-2498

VL - 44

SP - 236

EP - 245

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

IS - 2

ER -

Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device

Abstract

Bibliographical note

Funding

Keywords

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