Prognostic Value of Repeated Peak Oxygen Uptake Measurements in LVAD Patients - Follow Up on PRO-VAD Study

Mariusz K Szymanski, Kiran K Mirza, Nicolaas de Jonge, Thomas Schmidt, Darshan H Brahmbhatt, Filio Billia, Steven Hsu, Guy A MacGowan, Djordje G Jakovljevic, Piergiuseppe Agostoni, Filippo Trombara, Ulrich Jorde, Yogita Rochlani, Katrien Vandersmissen, Nils Reiss, Stuart D Russell, Bart Meyns, Finn Gustafsson

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Abstract

Purpose
Peak oxygen uptake (pVO2) measured few months after left ventricle assist device (LVAD) implantation has been shown to be of prognostic value. We examined whether repeated cardiopulmonary exercise test (CPET) can provide additional information in terms of prognostication.

Methods
We collected data of serial cardiopulmonary exercise tests (CPET) and outcomes in adult LVAD recipients in a retrospective, multicenter study. All patients who had their index CPET between 80-210 days from implantation and control CPET within 400 days but not earlier than 90 days after index CPET were included. Patients were grouped accordingly to pVO2 values with the cut-off values used as the indication for advanced heart failure therapy (≤14 ml/kg/min if the patient was not treated with beta-blockers (BB) or pVO2 ≤12 ml/kg/min if the patient was taking BB) resulting in four groups.

Results
Data from 153 patients were included in analysis. The mean age was 52±13 years, 68 % were male and the mean body mass index (BMI) at implantation was 25 ± 4 kg/m2. The majority (68%) had heart failure due to non-ischemic cardiomyopathy and 89% received LVAD as bridge to transplant or decision. The index CPET was performed at median of 183 days and the mean pVO2 was 15,4 ± 4,7 ml/kg/min. The control CPET was performed at median of 367 days after LVAD implantation and the mean pVO2 was 15,8 ± 4.9 ml/kg/min. Lower pVO2 values were strongly associated with poorer survival, both at index as well as at control CPET. Patients with low pVO2 values at both CPETs had significantly worse prognosis in comparison to other patients, with best prognosis in patients with persistent high or improved pVO2 (figure).

Conclusion
pVO2 measurements in LVAD patients have a prognostic value similar to heart failure patients not supported by mechanical circulatory support both early as well as 1 year after LVAD implantation. Repeated measurement are of additional value in identifying patients with the worst prognosis after LVAD implantation.
Original languageGerman
Article number340
JournalThe journal of heart and lung transplantation
Volume42
Issue number4 Supplement
Pages (from-to)S162
Number of pages1
ISSN1053-2498
DOIs
Publication statusPublished - 04.2023

Citation