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

doi:10.1016/j.amjcard.2009.12.053

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

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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 <1.8, L/min/m² (n = 27); group 3, Vo₂ <12 ml/min/kg, CI ≥1.8 L/min/m² (n = 25); and group 4, Vo₂ <12 ml/min/kg, CI <1.8 L/min/m² (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 language	English (US)
Pages (from-to)	1353-1355
Number of pages	3
Journal	American Journal of Cardiology
Volume	105
Issue number	9
DOIs	https://doi.org/10.1016/j.amjcard.2009.12.053
State	Published - May 1 2010

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.amjcard.2009.12.053

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Methvin, A., Georgiopoulou, V. V., Kalogeropoulos, A. P., Malik, A., Anarado, P., Chowdhury, M., Hussain, I., Book, W. M., Laskar, S. R., Vega, J. D., Smith, A. L., & Butler, J. (2010). Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation. American Journal of Cardiology, 105(9), 1353-1355. https://doi.org/10.1016/j.amjcard.2009.12.053

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', American Journal of Cardiology, vol. 105, no. 9, pp. 1353-1355. https://doi.org/10.1016/j.amjcard.2009.12.053

@article{15df3d08f1d049b6a1800dda86f14e7c,

title = "Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation",

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 <1.8, L/min/m2 (n = 27); group 3, Vo2 <12 ml/min/kg, CI ≥1.8 L/min/m2 (n = 25); and group 4, Vo2 <12 ml/min/kg, CI <1.8 L/min/m2 (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.",

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

year = "2010",

month = may,

day = "1",

doi = "10.1016/j.amjcard.2009.12.053",

language = "English (US)",

volume = "105",

pages = "1353--1355",

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TY - JOUR

T1 - Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation

AU - Methvin, Amanda

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

PY - 2010/5/1

Y1 - 2010/5/1

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 <1.8, L/min/m2 (n = 27); group 3, Vo2 <12 ml/min/kg, CI ≥1.8 L/min/m2 (n = 25); and group 4, Vo2 <12 ml/min/kg, CI <1.8 L/min/m2 (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.

AB - 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 <1.8, L/min/m2 (n = 27); group 3, Vo2 <12 ml/min/kg, CI ≥1.8 L/min/m2 (n = 25); and group 4, Vo2 <12 ml/min/kg, CI <1.8 L/min/m2 (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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Usefulness of Cardiac Index and Peak Exercise Oxygen Consumption for Determining Priority for Cardiac Transplantation

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