Key result
A Ve/VCO2 slope >34 during cardiopulmonary exercise testing was associated with worse transplant-free survival in ARVC/D patients compared to a slope ≤34 (HR 6.57; 95% CI 1.28-33.72; P=0.010).
Why the study?
CPET has an established role in risk stratification for advanced heart failure therapies, but its safety and prognostic utility had not been described in ARVC/D.
Does cardiopulmonary exercise testing safely predict transplant-free survival in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia?
Cohort (n=38)
Does cardiopulmonary exercise testing safely predict transplant-free survival in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia?
Hazard Ratio: 6.57 (95% CI 1.28–33.72)
p-value: p=0.010
CPET is safe in patients with ARVC/D, and the Ve/VCO2 slope can effectively risk-stratify these patients for heart transplantation referral.
CPET appears safe with prognostic value in ARVC/D; leaves open its role in transplant decisions pending prospective data.
Background Arrhythmogenic right ventricular cardiomyopathy/dysplasia ( ARVC /D) is characterized by high arrhythmic burden and progressive heart failure, which can prompt referral for heart transplantation. Cardiopulmonary exercise testing ( CPET ) has an established role in risk stratification for advanced heart failure therapies, but has not been described in ARVC /D. This study sought to determine the safety and prognostic utility of CPET in patients with ARVC /D. Methods and Results Using the Johns Hopkins ARVC /D Registry, we examined patients with ARVC /D undergoing CPET . Baseline characteristics and transplant‐free survival were compared on the basis of peak oxygen consumption (pVO2) (≤14 or >14 mL/kg per minute) and ventilatory efficiency (Ve/ VCO 2 slope ≤34 or >34). Thirty‐eight patients underwent 50 CPET s. There were no sustained arrhythmic events. Twenty‐nine patients achieved a maximal test. Patients with pVO2 ≤14 mL/kg per minute were more often men ( P =0.042) compared with patients with pVO2 >14 mL/kg per minute. Patients with Ve/ VCO 2 slope >34 tended to have more moderate/severe right ventricular dilation (7/9 [78%] versus 10/26 [38%]; P =0.060) and clinical heart failure (8/9 [89%] versus 13/26 [50%]; P =0.056) compared with patients with Ve/ VCO 2 slope ≤34. Patients who underwent heart transplantation were more likely to have clinical heart failure (10/10 [100%] versus 13/28 [46%]; P =0.003). Patients with Ve/ VCO 2 slope >34 had worse transplant‐free survival compared with patients with Ve/ VCO 2 slope ≤34 (n=35; hazard ratio, 6.57 [95% CI , 1.28–33.72]; log‐rank P =0.010), whereas transplant‐free survival was similar on the basis of pVO2 groups (n=29; hazard ratio, 3.38 [95% CI , 0.75–15.19]; log‐rank P =0.092). Conclusions CPET is safe to perform in patients with ARVC /D. Ve/ VCO 2 slope may be used for risk stratification and guide referral for heart transplantation in ARVC /D.
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Scheel et al. (2020) conducted a cohort in Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) (n=38). Ve/VCO2 slope >34 during cardiopulmonary exercise testing vs. Ve/VCO2 slope ≤34 was evaluated on Transplant-free survival (HR 6.57, 95% CI 1.28-33.72, p=0.010). A Ve/VCO2 slope >34 during cardiopulmonary exercise testing was associated with worse transplant-free survival in ARVC/D patients compared to a slope ≤34 (HR 6.57; 95% CI 1.28-33.72; P=0.010).
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