Hemodynamic exercise testing: A valuable tool in the selection of cardiac transplantation candidates

Don B. Chomsky, Chim C. Lang, Glenn H. Rayos, Yu Shyr, Tiong Keat Yeoh, Richard N. Pierson, Stacy F. Davis, John R. Wilson

研究成果: Article

147 引文 斯高帕斯(Scopus)

摘要

Background: Peak exercise oxygen consumption (V̇O2), a noninvasive index of peak exercise cardiac output (CO), is widely used to select candidates for heart transplantation. However, peak exercise V̇O2 can be influenced by noncardiac factors such as deconditioning, motivation, or body composition and may yield misleading prognostic information. Direct measurement of the CO response to exercise may avoid this problem and more accurately predict prognosis. Methods and Results: Hemodynamic and ventilatory responses to maximal treadmill exercise were measured in 185 ambulatory patients with chronic heart failure who had been referred for cardiac transplantation (mean left ventricular ejection fraction, 22±7%; mean peak V̇O2 12.9±3.0 mL · min-1 · kg-1). CO response to exercise was normal in 83 patients and reduced in 102. By univariate analysis, patients with normal CO responses had a better 1-year survival rate (95%) than did those with reduced CO responses (72%) (P<.0001). Survival in patients with peak V̇O2 of >14 mL · min-1 · kg-1 (88%) was not different from that of patients with peak V̇O2 of ≤14 mL · min-1 · kg-1 (79%) (P=NS). However, survival was worse in patients with peak V̇O2 of ≤10 mL · min-1 · kg-1 (52%) versus those with peak V̇O2 of >10 mL · min-1 · kg-1 (89%) (P<.0001). By Cox regression analysis, exercise CO response was the strongest independent predictor of survival (risk ratio, 4.3), with peak V̇O2, dichotomized at 10 mL · min-1 · kg-1 (risk ratio, 3.3) as the only other independent predictor. Patients with reduced CO responses trod peak V̇O2 of ≤10 mL · min-1 · kg-1 had an extremely poor 1-year survival rate (38%). Conclusions: Both CO response to exercise and peak exercise V̇O2 provide valuable independent prognostic information in ambulatory patients with heart failure. These variables should be used in combination to select potential heart transplantation candidates.

原文English
頁(從 - 到)3176-3183
頁數8
期刊Circulation
94
發行號12
DOIs
出版狀態Published - 1996 一月 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

指紋 深入研究「Hemodynamic exercise testing: A valuable tool in the selection of cardiac transplantation candidates」主題。共同形成了獨特的指紋。

  • 引用此

    Chomsky, D. B., Lang, C. C., Rayos, G. H., Shyr, Y., Yeoh, T. K., Pierson, R. N., Davis, S. F., & Wilson, J. R. (1996). Hemodynamic exercise testing: A valuable tool in the selection of cardiac transplantation candidates. Circulation, 94(12), 3176-3183. https://doi.org/10.1161/01.CIR.94.12.3176