Heart failure & cardiomyopathiesCohort study
Cardiopulmonary exercise test criteria for heart transplantation referral of patients with ambulatory heart failure in the current era
- retrospective analysis
Authors' conclusion
In contemporary practice, a peak VO 2 <12 mL/kg/min alone may not reliably identify patients with HF with sufficiently high short-term mortality to warrant heart transplantation referral. VE/VCO 2 and exercise oscillatory ventilation provide important additional risk stratification, supporting re-evaluation of transplant referral criteria to reflect improved HF management and outcomes.
Study context
- Population
- Patients with ambulatory heart failure with cardiopulmonary exercise testing data; primary analysis in those with left ventricular ejection fraction <40% and peak VO 2 <12 mL/kg/min, enrolled between 2010 and 2022primary analysis: 1218 patients with left ventricular ejection fraction <40% and peak VO 2 <12 mL/kg/min
- Participants
- 8,060 patients
- Exposure
- Survival outcomes (composite of death/left ventricular assist device/heart transplantation) were compared with those of heart transplantation recipients from the International Society for Heart and Lung Transplantation registry
- Patients with peak VO 2 <12 mL/kg/minn = 1,218
Main finding
As reported in the abstract
- Patients with peak VO 2 <12 mL/kg/min demonstrated better survival than heart transplantation recipients, with survival curves intersecting at approximately 2.7 years
Observational data: associations, not effects.
Further findings
Mortality risk among those with VE/VCO 2 ≤34 · 10-year
- 10-year mortality risk was halved; survival curves crossing those of heart transplantation recipients around year 4
- P < 0.01
Long-term mortality, absence of exercise oscillatory ventilation
- lower long-term mortality
- 50%
10-year outcomes, four risk groups combining VE/VCO 2 and exercise oscillatory ventilation
- four distinct risk groups with significantly different 10-year outcomes
- P < 0.01
Survival, peak VO 2 <12 mL/kg/min, VE/VCO 2 ≤34 and no exercise oscillatory ventilation · year 5
- survival comparable to heart transplantation recipients at year 5
Original publication
Summarised from the published abstract; every number is checked against it