Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device

William Herrik Nielsen*, Mariusz K Szymanski, Kiran K Mirza, Linda W Van Laake, Thomas Schmidt, Darshan H Brahmbhatt, Filio Billia, Steven Hsu, Guy MacGowan, Djordje G Jakovljevic, Piergiuseppe Agostoni, Filippo Trombara, Ulrich P Jorde, Yogita Rochlani, Katrien Vandersmissen, Nils Reiss, Stuart D Russell, Bart Meyns, Finn Gustafsson

*Corresponding author af dette arbejde
1 Citationer (Scopus)

Abstract

BACKGROUND: Peak oxygen uptake (pVO 2) predicts mortality in patients with heart failure on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO 2 measurements during long-term follow-up.

METHODS: This multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into 4 groups based on pVO 2 levels at the 2 CPETs: low at both tests, low at the first and high at the second test, high at the first and low at the second test, and high at both tests. Low pVO 2 was defined as ≤14 ml/kg/min (or ≤12 ml/kg/min if beta-blocker tolerant), while values above these thresholds were considered high. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis.

RESULTS: The study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO 2 improvement (median change: 0.4 ml/kg/min, p = 0.04). Persistently high pVO 2 (76 patients) was associated with a 5-fold reduction in mortality hazard (hazard ratio [HR] 0.20, p = 0.002), compared with persistently low pVO 2 (46 patients). Improvement from low to high pVO 2 (21 patients) displayed similar benefits (HR 0.21, p = 0.02).

CONCLUSIONS: pVO 2 measurements remain predictive of mortality upon reiteration in patients with LVAD, with changes in pVO 2 providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions.

OriginalsprogEngelsk
TidsskriftThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Vol/bind44
Udgave nummer2
Sider (fra-til)236-245
Antal sider10
ISSN1053-2498
DOI
StatusUdgivet - feb. 2025

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