Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation

Amanda Methvin, Vasiliki V. Georgiopoulou, Andreas P. Kalogeropoulos, Adnan Malik, Perry Anarado, Mahdi Chowdhury, Imad Hussain, Wendy M. Book, Sonjoy R. Laskar, J. David Vega, Andrew L. Smith, Javed Butler

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Decisions regarding cardiac transplantation listing are difficult in patients with heart failure who have relatively discordant peak exercise oxygen consumption (Vo2) and cardiac index (CI) values. One hundred five patients with heart failure who underwent cardiopulmonary exercise testing and right-sided cardiac catheterization for transplantation evaluation were studied. Patients were divided into 4 groups on the basis of peak Vo2 and CI: group 1, Vo2 ≥12 ml/min/kg, CI ≥1.8 L/min/m2 (n = 30); group 2, Vo2 ≥12 ml/min/kg, CI 2 (n = 27); group 3, Vo2 2 (n = 25); and group 4, Vo2 2 (n = 23). Groups were compared for event-free (death or ventricular assist device) survival. The overall CI was 1.9 ± 0.4 L/min/m2 and peak Vo2 was 12.4 ± 2.8 ml/min/kg; values in the 4 groups were as follows: group 1, peak Vo2 14.7 ± 2.1 ml/min/kg, CI 2.2 ± 0.3 L/min/m2; group 2, peak VO2 14.2 ± 1.3 ml/min/kg, CI 1.5 ± 0.2 L/min/m2; group 3, peak Vo2 10.2 ± 1.3 ml/min/kg, CI 2.1 ± 0.3 L/min/m2; and group 4, peak Vo2 9.7 ± 2.0 ml/min/kg, CI 1.6 ± 0.2 L/min/m2. After a median follow-up period of 3.7 years, 28 patients (26.0%) had events. Event-free survival was 96%, 95%, 96%, and 79% for 6 months (p = 0.04); 88%, 81%, 90%, and 73% for 12 months (p = 0.09); 88%, 73%, 85%, and 65% for 18 months (p = 0.11); and 83%, 73%, 79%, and 53% for 24 months (p = 0.06) for groups 1 to 4, respectively. Median survival was 5.1, 3.0, 3.9, and 2.6 years, respectively, in groups 1 to 4 (p = 0.052). In conclusion, almost half the patients had relatively discordant peak Vo2 and CI measurements. Patients with lower peak Vo2 values but relatively preserved CI values had survival comparable to post-transplantation survival, whereas those with low CI but preserved Vo2 had a lower survival rate. These results suggest that the former group may be safely monitored on medical therapy, whereas the latter may benefit from early listing.

Original languageEnglish (US)
Pages (from-to)1353-1355
Number of pages3
JournalThe American Journal of Cardiology
Volume105
Issue number9
DOIs
StatePublished - May 1 2010
Externally publishedYes

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Heart Transplantation
Oxygen Consumption
Exercise
Survival
Heart Failure
Heart-Assist Devices
Cardiac Catheterization
Disease-Free Survival
Survival Rate
Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Methvin, A., Georgiopoulou, V. V., Kalogeropoulos, A. P., Malik, A., Anarado, P., Chowdhury, M., ... Butler, J. (2010). Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation. The American Journal of Cardiology, 105(9), 1353-1355. https://doi.org/10.1016/j.amjcard.2009.12.053

Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation. / Methvin, Amanda; Georgiopoulou, Vasiliki V.; Kalogeropoulos, Andreas P.; Malik, Adnan; Anarado, Perry; Chowdhury, Mahdi; Hussain, Imad; Book, Wendy M.; Laskar, Sonjoy R.; Vega, J. David; Smith, Andrew L.; Butler, Javed.

In: The American Journal of Cardiology, Vol. 105, No. 9, 01.05.2010, p. 1353-1355.

Research output: Contribution to journalArticle

Methvin, A, Georgiopoulou, VV, Kalogeropoulos, AP, Malik, A, Anarado, P, Chowdhury, M, Hussain, I, Book, WM, Laskar, SR, Vega, JD, Smith, AL & Butler, J 2010, 'Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation', The American Journal of Cardiology, vol. 105, no. 9, pp. 1353-1355. https://doi.org/10.1016/j.amjcard.2009.12.053
Methvin, Amanda ; Georgiopoulou, Vasiliki V. ; Kalogeropoulos, Andreas P. ; Malik, Adnan ; Anarado, Perry ; Chowdhury, Mahdi ; Hussain, Imad ; Book, Wendy M. ; Laskar, Sonjoy R. ; Vega, J. David ; Smith, Andrew L. ; Butler, Javed. / Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation. In: The American Journal of Cardiology. 2010 ; Vol. 105, No. 9. pp. 1353-1355.
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AU - Georgiopoulou, Vasiliki V.

AU - Kalogeropoulos, Andreas P.

AU - Malik, Adnan

AU - Anarado, Perry

AU - Chowdhury, Mahdi

AU - Hussain, Imad

AU - Book, Wendy M.

AU - Laskar, Sonjoy R.

AU - Vega, J. David

AU - Smith, Andrew L.

AU - Butler, Javed

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N2 - Decisions regarding cardiac transplantation listing are difficult in patients with heart failure who have relatively discordant peak exercise oxygen consumption (Vo2) and cardiac index (CI) values. One hundred five patients with heart failure who underwent cardiopulmonary exercise testing and right-sided cardiac catheterization for transplantation evaluation were studied. Patients were divided into 4 groups on the basis of peak Vo2 and CI: group 1, Vo2 ≥12 ml/min/kg, CI ≥1.8 L/min/m2 (n = 30); group 2, Vo2 ≥12 ml/min/kg, CI 2 (n = 27); group 3, Vo2 2 (n = 25); and group 4, Vo2 2 (n = 23). Groups were compared for event-free (death or ventricular assist device) survival. The overall CI was 1.9 ± 0.4 L/min/m2 and peak Vo2 was 12.4 ± 2.8 ml/min/kg; values in the 4 groups were as follows: group 1, peak Vo2 14.7 ± 2.1 ml/min/kg, CI 2.2 ± 0.3 L/min/m2; group 2, peak VO2 14.2 ± 1.3 ml/min/kg, CI 1.5 ± 0.2 L/min/m2; group 3, peak Vo2 10.2 ± 1.3 ml/min/kg, CI 2.1 ± 0.3 L/min/m2; and group 4, peak Vo2 9.7 ± 2.0 ml/min/kg, CI 1.6 ± 0.2 L/min/m2. After a median follow-up period of 3.7 years, 28 patients (26.0%) had events. Event-free survival was 96%, 95%, 96%, and 79% for 6 months (p = 0.04); 88%, 81%, 90%, and 73% for 12 months (p = 0.09); 88%, 73%, 85%, and 65% for 18 months (p = 0.11); and 83%, 73%, 79%, and 53% for 24 months (p = 0.06) for groups 1 to 4, respectively. Median survival was 5.1, 3.0, 3.9, and 2.6 years, respectively, in groups 1 to 4 (p = 0.052). In conclusion, almost half the patients had relatively discordant peak Vo2 and CI measurements. Patients with lower peak Vo2 values but relatively preserved CI values had survival comparable to post-transplantation survival, whereas those with low CI but preserved Vo2 had a lower survival rate. These results suggest that the former group may be safely monitored on medical therapy, whereas the latter may benefit from early listing.

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