TY - JOUR
T1 - Prognostic value of repeated peak oxygen uptake measurements in patients with a left ventricular assist device
AU - Nielsen, William Herrik
AU - Szymanski, Mariusz K
AU - Mirza, Kiran K
AU - Van Laake, Linda W
AU - Schmidt, Thomas
AU - Brahmbhatt, Darshan H
AU - Billia, Filio
AU - Hsu, Steven
AU - MacGowan, Guy
AU - Jakovljevic, Djordje G
AU - Agostoni, Piergiuseppe
AU - Trombara, Filippo
AU - Jorde, Ulrich P
AU - Rochlani, Yogita
AU - Vandersmissen, Katrien
AU - Reiss, Nils
AU - Russell, Stuart D
AU - Meyns, Bart
AU - Gustafsson, Finn
N1 - Copyright © 2024. Published by Elsevier Inc.
PY - 2025/2
Y1 - 2025/2
N2 - 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.
AB - 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.
KW - Adult
KW - Exercise Test
KW - Female
KW - Follow-Up Studies
KW - Heart Failure/physiopathology
KW - Heart-Assist Devices
KW - Humans
KW - Male
KW - Middle Aged
KW - Oxygen Consumption/physiology
KW - Prognosis
KW - Retrospective Studies
KW - Survival Rate/trends
KW - pVO
KW - left ventricular assist devices
KW - prognosis
KW - peak oxygen uptake
KW - repeated cardiopulmonary exercise testing
UR - http://www.scopus.com/inward/record.url?scp=85208174861&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2024.10.003
DO - 10.1016/j.healun.2024.10.003
M3 - Journal article
C2 - 39426458
SN - 1053-2498
VL - 44
SP - 236
EP - 245
JO - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
IS - 2
ER -