Abstract 16600: Prognostic Value of Peak Exercise Oxygen Consumption and Bnp Levels in Ambulatory Patients With Advanced Heart Failure Undergoing Evaluation for Heart Transplantation
Background. Peak exercise oxygen consumption (VO2max) is widely used to select candidates for heart transplantation (HTx). The use of beta-blockers has shifted the prognostic impact of VO2max and the impact of moderately decreased VO2max (10 to 14 mL/kg/min) on prognosis without HTx is not fully elucidated. Novel biomarkers e.g. brain natriuretic peptide (BNP) are potentially useful prognostic tools in patients (pts) with heart failure (HF). We tested the prognostic impact of a combination of VO2max and BNP in ambulatory pts with HF.
Methods. We analyzed 424 pts who underwent cardiopulmonary exercise testing (CPET) at Columbia University Medical Center between 2005 and 2009. Survival of pts (end-point: death, ventricular assist device or HTx) who had preserved (>14 ml/kg/min), moderately decreased (10-14 mL/kg/min) or low VO2max (<10 mL/kg/min) was compared. Each group of pts was further dichotomized according to the cut-off value of BNP associated with survival in those with VO2max of 10-14 mL/kg/min. Survival was compared to post-transplant survival of 743 HTx recipients at our institution between 1999 and 2010.
Results. Pts with VO2max>14 mL/kg/min showed better survival and pts with VO2max<10 mL/kg/min showed worse survival than pts undergoing HTx regardless of BNP values. In pts with VO2max 10-14 mL/kg/min, a BNP cut-off value for survival was determined at 325 pg/mL. Pts with VO2max 10-14 mL/kg/min and BNP<325 pg/mL showed better survival than HTx recipients (96% vs. 87% at 1 yr; p=0.023). Conversely, patients with VO2max 10-14 mL/kg/min and BNP≥325 pg/mL showed higher mortality compared to HTx recipients (82% vs. 87%; p=0.040)(Figure). Of note, BNP and VO2max did not correlate in any of the groups of pts.
Conclusions. The combination of exercise performance and BNP measurements is useful to characterize pts with HF undergoing evaluation for HTx. These findings apply to ambulatory pts stable for CPET, who are in a euvolemic state and on optimized medical therapy.
- © 2011 by American Heart Association, Inc.