Objectives

The purpose of this study was to examine whether peak oxygen uptake (pVO₂) and other cardiopulmonary exercise test (CPET)-derived variables could predict intermediate-term mortality in stable continuous flow LVAD recipients.

Background

pVO₂ is a cornerstone in the selection of patients for heart transplantation, but the prognostic power of pVO₂ obtained in patients treated with a left ventricular assist device (LVAD) is unknown.

Methods

We collected data for pVO₂ and outcomes in adult LVAD recipients in a retrospective, multicenter study and evaluated cutoff values for pVO₂ including: 1) values above or below medians; 2) grouping patients in tertiles; and 3) pVO₂ ≤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 therapy.

Results

Nine centers contributed data from 450 patients. Patients were 53 ± 13 years of age; 78% were male; body mass index was 25 ± 5 kg/m² with few comorbidities (stroke: 11%; diabetes: 18%; and peripheral artery disease: 4%). The cause of heart failure (HF) was most often nonischemic (66%). Devices included were the HeartMate II and 3 (Abbott); and Heartware ventricular assist devices Jarvik and Duraheart (Medtronic). The index CPET was performed at a median of 189 days (154-225 days) after LVAD implantation, and mean pVO₂ was 14.1 ± 5 ml/kg/min (47% ± 14% of predicted value). Lower pVO₂ values were strongly associated with poorer survival regardless of whether patients were analyzed for absolute pVO₂ in ml/kg/min, pVO₂ ≤12 BB/14 ml/kg/min, or as a percentage of predicted pVO₂ values (P ≤ 0.001 for all). For patients with pVO₂ >12 BB/14 and ventilation/carbon dioxide relationship (VE/VCO₂) slope <35, the 1-year survival was 100%.

Conclusions

Even after LVAD implantation, pVO₂ has prognostic value, similar to HF patients not supported by mechanical circulatory support devices. (PROgnostic Value of Exercise Capacity Measured as Peak Oxygen Uptake [pVO₂] in Recipients of Left Ventricular Assist Devices [PRO-VAD]; NCT04423562)

中文翻译：

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左心室辅助装置 (PRO-VAD) 支持患者的峰值摄氧量的预后价值

目标

本研究的目的是检查峰值摄氧量 (pV O ₂ ) 和其他心肺运动试验 (CPET) 衍生的变量是否可以预测稳定连续流 LVAD 受者的中期死亡率。

背景

pV O ₂是选择心脏移植患者的基石，但在接受左心室辅助装置 (LVAD) 治疗的患者中获得的 pV O ₂的预后能力尚不清楚。

方法

我们在一项回顾性、多中心研究中收集了成年 LVAD 受者的pV O ₂和结局数据，并评估了 pV O _{2 的}临界值，包括：1) 高于或低于中位数的值；2) 将患者按三分位数分组；和 3) pV O ₂  ≤14 ml/kg/min 如果患者未接受 β 受体阻滞剂 (BB) 治疗或 pV O ₂  ≤12 ml/kg/min 如果患者正在接受 BB 治疗。

结果

九个中心提供了来自 450 名患者的数据。患者年龄为 53 ± 13 岁；78% 是男性；体重指数为 25 ± 5 kg/m ²，几乎没有合并症（中风：11%；糖尿病：18%；外周动脉疾病：4%）。心力衰竭 (HF) 的原因通常是非缺血性的 (66%)。包括的设备是 HeartMate II 和 3（雅培）；和 Heartware 心室辅助设备 Jarvik 和 Duraheart（美敦力）。在 LVAD 植入后平均 189 天（154-225 天）进行指数 CPET，平均 pV O ₂为 14.1 ± 5 ml/kg/min（预测值的 47% ± 14%）。无论是否对患者进行绝对 pV O ₂分析，较低的 pV O ₂值都与较差的生存率密切相关以 ml/kg/min、pV O ₂  ≤12 BB/14 ml/kg/min 或作为预测 pV O ₂值的百分比（ 所有P ≤ 0.001）。对于 pV O ₂ >12 BB/14 且通气/二氧化碳关系（VE/VC O ₂）斜率 <35 的患者，1 年生存率为 100%。

结论

即使在 LVAD 植入后，pV O ₂也具有预后价值，类似于没有机械循环支持装置支持的 HF 患者。（在左心室辅助装置 [PRO-VAD] 的接受者中，以峰值摄氧量 [pV O ₂ ]衡量的运动能力的预后价值；NCT04423562）