Circulation, Vol 83, 778-786, Copyright © 1991 by American Heart Association
DM Mancini, H Eisen, W Kussmaul, R Mull, LH Edmunds Jr and JR Wilson
BACKGROUND. Optimal timing of cardiac transplantation in ambulatory
patients with severe left ventricular dysfunction is often difficult. To
determine whether measurement of peak oxygen consumption (VO2) during
maximal exercise testing can be used to identify patients in whom
transplantation can be safely deferred, we prospectively performed exercise
testing on all ambulatory patients referred for transplant between October
1986 and December 1989. METHODS AND RESULTS. Patients were assigned into
one of three groups on the basis of exercise data: Group 1 (n = 35)
comprised patients accepted for transplant (VO2 less than or equal to 14
ml/kg/min); group 2 (n = 52) comprised patients considered too well for
transplant (VO2 greater than 14 ml/kg/min); and group 3 (n = 27) comprised
patients with low VO2 rejected for transplant due to noncardiac problems.
All three groups were comparable in New York Heart Association functional
class, ejection fraction, and cardiac index (p = NS). Pulmonary capillary
wedge pressure was significantly lower in group 2 than in either group 1 or
3 (p less than 0.05), although there was wide overlap. Patients with
preserved exercise capacity (group 2) had cumulative 1- and 2-year survival
rates of 94% and 84%, which are equal to survival levels after
transplantation. In contrast, patients rejected for transplant (group 3)
had survival rates of only 47% at 1 year and 32% at 2 years, whereas
patients awaiting transplantation (group 1) had a survival rate of 70% at 1
year (both p less than 0.005 versus patients with VO2 greater than 14
ml/kg/min). All deaths in group 2 were sudden. By univariate and
multivariate analyses, peak VO2 was the best predictor of survival, with
only pulmonary capillary wedge pressure providing additional prognostic
information. CONCLUSIONS. These data suggest that cardiac transplantation
can be safely deferred in ambulatory patients with severe left ventricular
dysfunction and peak exercise VO2 of more than 14 ml/min/kg.
ARTICLES
Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure
Cardiovascular Section, Hospital of the University of Pennsylvania, Philadelphia 19104.
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U. Corra, A. Mezzani, E. Bosimini, and P. Giannuzzi Cardiopulmonary Exercise Testing and Prognosis in Chronic Heart Failure*: A Prognosticating Algorithm for the Individual Patient Chest, September 1, 2004; 126(3): 942 - 950. [Abstract] [Full Text] [PDF]
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J. O. O'Neill, J. B. Young, C. E. Pothier, and M. S. Lauer Severe frequent ventricular ectopy after exercise as a predictor of death in patients with heart failure J. Am. Coll. Cardiol., August 18, 2004; 44(4): 820 - 826. [Abstract] [Full Text] [PDF]
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R. V. Milani, C. J. Lavie, and M. R. Mehra Cardiopulmonary Exercise Testing: How Do We Differentiate the Cause of Dyspnea? Circulation, July 27, 2004; 110(4): e27 - e31. [Full Text] [PDF]
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M. C. Limacher Understanding the impact of abnormal cardiac activation on cardiac function J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1532 - 1533. [Full Text] [PDF]
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P. de Groote, J. Dagorn, B. Soudan, N. Lamblin, E. McFadden, and C. Bauters B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1584 - 1589. [Abstract] [Full Text] [PDF]
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P. de Groote, N. Lamblin, F. Mouquet, D. Plichon, E. McFadden, E. Van Belle, and C. Bauters Impact of diabetes mellitus on long-term survival in patients with congestive heart failure Eur. Heart J., April 2, 2004; 25(8): 656 - 662. [Abstract] [Full Text] [PDF]
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J. N. Nanas, E. P. Tsagalou, J. Kanakakis, S. N. Nanas, J. V. Terrovitis, T. Moon, and M. I. Anastasiou-Nana Long-term Intermittent Dobutamine Infusion, Combined With Oral Amiodarone for End-Stage Heart Failure: A Randomized Double-Blind Study Chest, April 1, 2004; 125(4): 1198 - 1204. [Abstract] [Full Text] [PDF]
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J. Butler, G. Khadim, K. M. Paul, S. F. Davis, M. W. Kronenberg, D. B. Chomsky, R. N. Pierson III, and J. R. Wilson Selection of patients for heart transplantationin the current era of heart failure therapy J. Am. Coll. Cardiol., March 3, 2004; 43(5): 787 - 793. [Abstract] [Full Text] [PDF]
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M. C. Deng Heart transplantation: the increasing challenges of evidence-based decision-making J. Am. Coll. Cardiol., March 3, 2004; 43(5): 803 - 805. [Full Text] [PDF]
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M. Hulsmann, M. Quittan, R. Berger, R. Crevenna, C. Springer, M. Nuhr, D. Mortl, P. Moser, and R. Pacher Muscle strength as a predictor of long-term survival in severe congestive heart failure Eur J Heart Fail, January 1, 2004; 6(1): 101 - 107. [Abstract] [Full Text] [PDF]
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L. W. Stevenson and E. A. Rose Left Ventricular Assist Devices: Bridges to Transplantation, Recovery, and Destination for Whom? Circulation, December 23, 2003; 108(25): 3059 - 3063. [Full Text] [PDF]
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A. Auricchio, C. Stellbrink, C. Butter, S. Sack, J. Vogt, A. R. Misier, D. Bocker, M. Block, J. H. Kirkels, Pacing Therapies in Congestive Heart Failure (PATH, et al. Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2109 - 2116. [Abstract] [Full Text] [PDF]
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J. Myers, O. Geiran, S. Simonsen, A. Ghuyoumi, and L. Gullestad Clinical and Exercise Test Determinants of Survival After Cardiac Transplantation Chest, November 1, 2003; 124(5): 2000 - 2005. [Abstract] [Full Text] [PDF]
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R.S. Gardner, F. Ozalp, A.J. Murday, S.D. Robb, and T.A. McDonagh N-terminal pro-brain natriuretic peptide: A new gold standard in predicting mortality in patients with advanced heart failure Eur. Heart J., October 1, 2003; 24(19): 1735 - 1743. [Abstract] [Full Text] [PDF]
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Y. Taniguchi, K. Ueshima, I. Chiba, I. Segawa, N. Kobayashi, M. Saito, and K. Hiramori A New Method Using Pulmonary Gas-Exchange Kinetics To Evaluate Efficacy of {beta}-Blocking Agents in Patients With Dilated Cardiomyopathy Chest, September 1, 2003; 124(3): 954 - 961. [Abstract] [Full Text] [PDF]
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M. N. Walsh and M. E. Tavel Evaluation and Management of a Patient With Congestive Heart Failure Chest, August 1, 2003; 124(2): 728 - 731. [Full Text] [PDF]
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H. Rickli, W. Kiowski, M. Brehm, D. Weilenmann, C. Schalcher, A. Bernheim, E. Oechslin, and H. P. Brunner-La Rocca Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure J. Am. Coll. Cardiol., July 2, 2003; 42(1): 116 - 122. [Abstract] [Full Text] [PDF]
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V. Bittner Exercise testing in heart failure: Maximal, submaximal, or both? J. Am. Coll. Cardiol., July 2, 2003; 42(1): 123 - 125. [Full Text] [PDF]
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J. J. Leite, A. J. Mansur, H. F. G. de Freitas, P. R. Chizola, E. A. Bocchi, M. Terra-Filho, J. A. Neder, and G. Lorenzi-Filho Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2175 - 2181. [Abstract] [Full Text] [PDF]
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C. Rostagno, G. Olivo, M. Comeglio, V. Boddi, M. Banchelli, G. Galanti, and G. F. Gensini Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation Eur J Heart Fail, June 1, 2003; 5(3): 247 - 252. [Abstract] [Full Text] [PDF]
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M. Arzt, M. Harth, A. Luchner, F. Muders, S. R. Holmer, F. C. Blumberg, G. A.J. Riegger, and M. Pfeifer Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Central Sleep Apnea Circulation, April 22, 2003; 107(15): 1998 - 2003. [Abstract] [Full Text] [PDF]
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S. D. Anker, W. Doehner, M. Rauchhaus, R. Sharma, D. Francis, C. Knosalla, C. H. Davos, M. Cicoira, W. Shamim, M. Kemp, et al. Uric Acid and Survival in Chronic Heart Failure: Validation and Application in Metabolic, Functional, and Hemodynamic Staging Circulation, April 22, 2003; 107(15): 1991 - 1997. [Abstract] [Full Text] [PDF]
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S. Bonapace, A. Rossi, M. Cicoira, L. Franceschini, G. Golia, L. Zanolla, P. Marino, and P. Zardini Aortic Distensibility Independently Affects Exercise Tolerance in Patients With Dilated Cardiomyopathy Circulation, April 1, 2003; 107(12): 1603 - 1608. [Abstract] [Full Text] [PDF]
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A. Koike, N. Shimizu, A. Tajima, T. Aizawa, L. T. Fu, H. Watanabe, and H. Itoh Relation Between Oscillatory Ventilation at Rest Before Cardiopulmonary Exercise Testing and Prognosis in Patients With Left Ventricular Dysfunction Chest, February 1, 2003; 123(2): 372 - 379. [Abstract] [Full Text] [PDF]
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