Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation

Naohiko Osada, Bernard R. Chaitman, Leslie W. Miller, Daniel Yip, Mary Beth Cishek, Thomas L. Wolford, Thomas J. Donohue

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Objectives. The 3-year survival rates of 500 patients with congestive heart failure (CHF) referred for heart transplantation were assessed to evaluate the clinical and exercise variables most useful for estimating prognostic risk. Background. Detailed prognostic risk stratification of patients with a peak exercise oxygen consumption (Vo2) ≤14 ml/min per kg to identify lower risk patient subsets has been limited in earlier series by relatively small sample size. Methods. Cardiopulmonary exercise testing was performed in 500 patients with CHF referred for heart transplantation; 154 (31%) had a peak exercise Vo2 ≤14 ml/min per kg. Univariate and multivariate analyses were performed to identify the 3-year prognostic risk. Results. The 55% 3-year survival rate of the 77 patients with a peak exercise Vo2 ≤14 ml/min per kg unable to reach a peak exercise systolic blood pressure (SBP) of 120 mm Hg was significantly lower than the 83% survival rate in the 74 patients able to reach this exercise blood pressure (p = 0.004). Multivariate analysis revealed that peak exercise SBP (p = 0.0005) and percent predicted peak Vo2 ≤ 50% (p = 0.04) were the two most important predictors for the combined end point of death or listing as Status 1. Conclusions. Peak exercise SBP and percent predicted peak exercise Vo2 are two inexpensive and easily measured noninvasive variables that can be used to further prognostically risk stratify ambulatory patients with CHF referred for heart transplantation with a peak exercise Vo2 ≤14 ml/min per kg.

Original languageEnglish (US)
Pages (from-to)577-582
Number of pages6
JournalJournal of the American College of Cardiology
Volume31
Issue number3
DOIs
StatePublished - Mar 1998
Externally publishedYes

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Heart Transplantation
Heart Failure
Exercise
Blood Pressure
Survival Rate
Multivariate Analysis
Oxygen Consumption
Sample Size

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. / Osada, Naohiko; Chaitman, Bernard R.; Miller, Leslie W.; Yip, Daniel; Cishek, Mary Beth; Wolford, Thomas L.; Donohue, Thomas J.

In: Journal of the American College of Cardiology, Vol. 31, No. 3, 03.1998, p. 577-582.

Research output: Contribution to journalArticle

Osada, Naohiko ; Chaitman, Bernard R. ; Miller, Leslie W. ; Yip, Daniel ; Cishek, Mary Beth ; Wolford, Thomas L. ; Donohue, Thomas J. / Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. In: Journal of the American College of Cardiology. 1998 ; Vol. 31, No. 3. pp. 577-582.
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abstract = "Objectives. The 3-year survival rates of 500 patients with congestive heart failure (CHF) referred for heart transplantation were assessed to evaluate the clinical and exercise variables most useful for estimating prognostic risk. Background. Detailed prognostic risk stratification of patients with a peak exercise oxygen consumption (Vo2) ≤14 ml/min per kg to identify lower risk patient subsets has been limited in earlier series by relatively small sample size. Methods. Cardiopulmonary exercise testing was performed in 500 patients with CHF referred for heart transplantation; 154 (31{\%}) had a peak exercise Vo2 ≤14 ml/min per kg. Univariate and multivariate analyses were performed to identify the 3-year prognostic risk. Results. The 55{\%} 3-year survival rate of the 77 patients with a peak exercise Vo2 ≤14 ml/min per kg unable to reach a peak exercise systolic blood pressure (SBP) of 120 mm Hg was significantly lower than the 83{\%} survival rate in the 74 patients able to reach this exercise blood pressure (p = 0.004). Multivariate analysis revealed that peak exercise SBP (p = 0.0005) and percent predicted peak Vo2 ≤ 50{\%} (p = 0.04) were the two most important predictors for the combined end point of death or listing as Status 1. Conclusions. Peak exercise SBP and percent predicted peak exercise Vo2 are two inexpensive and easily measured noninvasive variables that can be used to further prognostically risk stratify ambulatory patients with CHF referred for heart transplantation with a peak exercise Vo2 ≤14 ml/min per kg.",
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