Key result
Lower pre-transplant peak VO2 predicted post-transplant exercise improvement (OR 0.69, P=0.017), while post-transplant BMI (HR 1.16) and VE/VCO2 slope (HR 1.07) predicted mortality.
Why the study?
What are the predictors of exercise capacity improvement and mortality in heart transplantation recipients?
Cohort (n=49)
What are the predictors of exercise capacity improvement and mortality in heart transplantation recipients?
Odds Ratio: 0.69
p-value: p=0.017
CHF patients with only moderate impairment of peak VO2 may not significantly improve exercise performance after HT, and post-HT BMI ≥28 and VE/VCO2 slope ≥47 are modifiable risk factors for death.
May inform post-HT risk stratification; hypothesis-generating in Level 3 data and requires prospective validation.
Survival and exercise performance are key targets of heart transplantation (HT). We designed this study to help in identifying (1) patients with chronic heart failure (CHF) at risk of poor exercise capacity after HT and (2) HT recipients presenting risk factors modifiable with exercise showing a potential impact on outcome. We enrolled 49 HT recipients (age 52 ± 12 years, 84% males) who underwent a cardiopulmonary exercise test before (9 ± 6 months) and after (20 ± 14 months) HT. In the CHF phase, lower peak oxygen consumption (VO(2) ) (odds ratio 0.69, P=0.017) independently predicted peak VO(2) improvement after HT. In the post-HT phase, body mass index (BMI) [adjusted hazard ratio (HR) 1.16, P=0.034] and VE (ventilation)/VCO(2) (carbon dioxide production) slope (adjusted HR 1.07, P=0.031) independently predicted mortality. In conclusion, CHF patients with only a moderate impairment of peak VO(2) are at a risk of failing to achieve a significant improvement of exercise performance after HT. In the post-HT phase, a BMI≥28 and/or a VE/VCO(2) slope ≥47 represent risk factors for death, which are potentially modifiable with exercise. Prospective randomized studies are needed to analyze the effects of training on functional capacity and outcome in the different subsets of HT recipients.
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Grigioni et al. (2010) conducted a cohort in Heart transplantation (n=49). Lower peak oxygen consumption (VO2) was evaluated on Peak VO2 improvement after HT (OR 0.69, p=0.017). Lower pre-transplant peak VO2 predicted post-transplant exercise improvement (OR 0.69, P=0.017), while post-transplant BMI (HR 1.16) and VE/VCO2 slope (HR 1.07) predicted mortality.
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