Predictive factors of maximal aerobic capacity after cardiac transplantation

Abstract

Exercise capacity in cardiac transplanted patients has been reported to remain decreased in some studies; however, functional results after transplantation may vary, ranging from modest to spectacular improvement. The aim of the study was to quantify exercise capacity in a large series of transplanted patients and to search for factor predictive of a good functional result. Eighty-five patients (mean 52.1 +/- 11.8 years) underwent exercise testing with respiratory gas exchange measurements 1 to 100 months after transplantation. Mean performance was 112.4 +/- 33 W with a peak VO2 of 21.1 +/- 6 ml.min-1.kg-1. Heart rate was 103 +/- 14 at rest, reaching 142 +/- 22 beats.min-1 at the end of exercising. In univariate analysis, maximal or submaximal aerobic capacity parameters were strongly correlated with chronotropic reserve (r = 0.63; P < 0.001) without correlation with cold ischaemic time, number of rejection episodes or right bundle branch block. In multiple regression analysis, chronotropic reserve, time from transplantation, age of donor and age of patient were proved to be the variables best correlated with peak VO2. Our study confirms the persistence of a large decrease in aerobic functional capacity despite cardiac transplantation; limited exercise capacity does not improve over time, and is limited not only by the patient's age but by that of the donor, and especially by chronotropic reserve.

Clinical and Exercise Test Determinants of Survival After Cardiac Transplantation *

“…9,12 However, the post-CTX peak V o 2 represents only 70% of the age-predicted value, confirming the fact that exercise capacity remains markedly reduced relative to individuals with intact hearts of similar age. [13][14][15] Resting HR was high (97 beats/min) and peak HR was limited (147 beats/min), consistent with an impaired chronotropic response to exercise. The limited range within which HR increased (50 beats/min) likely contributed to limiting cardiac output and thus peak V o 2 .…”

Exercise after heart transplantation

“…1 Peak oxygen uptake rate (V _O 2 ) values as a function of age and time after transplantation (s>1 year, d<1 year). Data are from: Banner et al 1989a, b;Beniaminovitz et al 1998;Braith et al 1992Braith et al , 1998bBrubaker et al 1993;Calzolari et al 1998;Caru`et al 1992;Cerretelli et al 1988Cerretelli et al , 1992Christos et al 1992;Daida et al 1996;Douard et al 1997;Ehrman et al 1992;Ewert et al 2000;Felici et al 1996;Ferretti et al 2002;Frist et al 1992;Geny et al 1998;Givertz et al 1997;Gullestad et al 1996;Hall et al 1994;Holm et al 2000;Hsu et al 1993;Jensen et al 1991;Kao et al 1994Kao et al , 1995Kavanagh et al 1988;Kemp et al 1995;Keteyian et al 1991Keteyian et al , 1994Labovitz et al 1989;Lampert et al 1996Lampert et al , 1998Mandak et al 1995;Marconi et al 2002;Marzo et al 1992;M'Bouh et al 2001;Mettauer et al 1996Mettauer et al , 2000Nixon et al 1995;Notarius et al 1998;…”

“…2 Peak V _O 2 values of middle-aged heart transplant recipients examined at least 18 months after transplantation. Data are taken from 15 papers published before 1998 (<1998) (Braith et al 1992;Cerretelli et al 1992;Daida et al 1996;Douard et al 1997;Givertz et al 1997;Gullestad et al 1996;Jensen et al 1991;Kao et al 1995;Kemp et al 1995;Keteyian et al 1994;Mandak et al 1995;Osada et al 1997;Quigg et al 1989;Renlund et al 1996;Savin et al 1980) and 15 papers published after 1998 (>1998) (Beniaminovitz et al 1998;Ewert et al 2000;Ferretti et al 2002;Geny et al 1998;Holm et al 2000;Marconi et al 2002;Mettauer et al 2000;Piquard et al 2000;Quigg et al 1998;Richard et al 1999;Schmidt et al 2002;Schwaiblmair et al 1999a, b;Ville et al 1998;Wilson et al 2000) Fig. 3 Longitudinal assessment of peak V _O 2 before and after transplantation in adult heart transplant recipients (A-HTR).…”

Parasympathetic Reinnervation Accompanied by Improved Post-Exercise Heart Rate Recovery and Quality of Life in Heart Transplant Recipients

“…Sympathetic reinnervation Exercise capacity in HTx recipients is decreased compared with normal subjects, 18) mainly due to cardiac total denervation.…”