Peak oxygen uptake and self‐reported physical health are strong predictors of long‐term survival after heart transplantation

Abstract

Background Peak oxygen uptake (VO2peak) is known as the gold standard measure of cardiopulmonary fitness. We therefore hypothesized that measures of physical health would predict long‐term survival in heart transplant recipients (HTx). Methods This retrospective study investigated survival in two HTx populations; the cardiopulmonary exercise test (CPET) cohort comprised 178 HTx patients who completed a VO2peak test during their annual follow‐up (1990–2003), and the SF‐36 cohort comprised 133 patients who completed a quality of life questionnaire, SF‐36v1 (1998–2000). Results Mean (SD) age in the CPET cohort was 52 (12) yr and 54 (11) yr in the SF‐36 cohort. Mean observation time was, respectively, 11 and 10 yr. Mean (SD) VO2peak was 19.6 (5.3) mL/kg/min, and median (IR) physical function (PF) score was 90 (30). VO2peak and PF scores were both significant predictors in univariate Cox regression. Multiple Cox regression analyses adjusted for other potential predictors showed that VO2peak, age, and cardiac allograft vasculopathy (CAV) were the most important predictors in the CPET cohort, whereas age, PF score, smoking, and CAV were the most important predictors in the SF‐36 cohort. In Kaplan–Meier analysis, VO2peak and PF scores above the median value were related to significant longer survival time. Conclusion Peak oxygen uptake and self‐reported physical health are strong predictors for long‐term survival in HTx recipients. VO2peak is a crucial measurement and should be more frequently used after HTx.

Long‐term effects of high‐intensity interval training in heart transplant recipients: A 5‐year follow‐up study of a randomized controlled trial

“…Furthermore, the study population had an aerobic performance with a mean VO 2peak of 75% of expected age‐matched values, which is above the normal range described after HTx . These results are likely to be relevant to overall prognosis, as recent studies have demonstrated an important association between cardiac rehabilitation, physical capacity, and self‐reported physical health on long‐term survival in HTx recipients …”

“…Several studies have demonstrated that regular exercise training improves exercise capacity and peak oxygen uptake (VO 2peak ) in heart transplant (HTx) patients, but their capacity still remains subnormal compared with the age‐matched values in a general population . Because both reduced physical exercise capacity and self‐reported physical health appear to be associated with reduced survival, an exercise training program following a transplantation should be of high importance. This is strongly supported in patients with heart failure and cardiovascular disease…”

Factors of Life Quality Improvement After Heart Transplantation: Predictive Significance of Cardiopulmonary Exercise Test

“…Уровень пикового VO 2 , равный 10,3 (9,(4)(5)(6)(7)(8)(9)(10)(11)6) мл/мин/кг и VE/VCO 2 slope, равный 42 (35-46), полу-ченные в нашем исследовании, свидетельствуют о плохом прогнозе заболевания и являются показа-нием для трансплантации сердца [11].…”

“…Уро-вень качества жизни не только позволяет оценить субъективное восприятие пациентом эффективности проведенного лечения и возможности адаптации в социальной среде после операции, но и сам по себе имеет высокую предикторную ценность в отношении долгосрочной выживаемости [6,7]. Предполагается, что повышение толерантности к физической нагрузке после трансплантации сердца должно сопровож-даться повышением качества жизни.…”

Reliability and Physiological Interpretation of Pulmonary Gas Exchange by “Circulatory Equivalents” in Chronic Heart Failure

“…[2][3][4] Peak oxygen uptake ( _ VO 2peak ), 5 end-tidal gas tensions, 6 and oscillatory breathing 7,8 measured by cardiopulmonary exercise testing (CPET) are prognostic of mortality in HF, and _ VO 2peak and lactate threshold (LT) are used for risk stratification, such as to guide suitability for transplant. 4,[9][10][11] The relationship between ventilation ( _ V E ) and carbon dioxide output ( _ VCO 2 ) (either as the _ V E = _ VCO 2 slope, or the value of _ V E = _ VCO 2 at a specified submaximal metabolic rate; eg, at LT or the ventilatory compensation point [VCP]), typically provides one of the strongest prognosticators, [12][13][14] either independently or in combination with other CPET and non-CPET variables. 15,16 Recently, the ratios of pulmonary gas exchange to ventilation ( _ VO 2 = _ V E and _ VCO 2 = _ V E , termed circulatory equivalents) have been added to the list of CPET-derived variables.…”