Cardiopulmonary Exercise Testing Identifies Low Risk Patients With Heart Failure and Severely Impaired Exercise Capacity Considered for Heart Transplantation

Objectives. The 3-year survival rates of 500 patients with congestive heart failure (CHF) referred for heart transplantation were assessed to evaluate the clinical and exercise variables most useful for estimating prognostic risk. Background. Detailed prognostic risk stratification of patients with peak exercise oxygen consumption (Vimage2) 14 ml/min per kg to identify lower risk patient subsets has been limited in earlier series by relatively small sample size. Methods. Cardiopulmonary exercise testing was performed in 500 patients with CHF referred for heart transplantation; 154 (31%) had peak exercise Vimage2 ≤14 ml/min per kg. Univariate and multivariate analyses were performed to identify the 3-year prognostic risk. Results. The 55% 3-year survival rate of the 77 patients with peak exercise Vimage2 ≤14 ml/min per kg unable to reach peak exercise systolic blood pressure (SBP) of 120 mm Hg was significantly lower than the 83% survival rate in the 74 patients able to reach this exercise blood pressure (p = 0.004). Multivariate analysis revealed that peak exercise SBP (p = 0.0005) and percent predicted peak Vimage2 ≤50% (p = 0.04) were the two most important predictors for the combined end point of death or listing as Status 1. Conclusions. Peak exercise SBP and percent predicted peak exercise Vimage2 are two inexpensive and easily measured noninvasive variables that can be used to further prognostically risk stratify ambulatory patients with CHF referred for heart transplantation with peak exercise Vimage2 ≤14 ml/min per kg.