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Prognostic Value of Peak Oxygen Uptake in Patients Supported With Left Ventricular Assist Devices (PRO-VAD). | LitMetric

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

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

Methods: We collected data for pVO and outcomes in adult LVAD recipients in a retrospective, multicenter study and evaluated cutoff values for pVO including: 1) values above or below medians; 2) grouping patients in tertiles; and 3) pVO ≤14 ml/kg/min if the patient was not treated with beta-blockers (BB) or pVO ≤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/m 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 pVO was 14.1 ± 5 ml/kg/min (47% ± 14% of predicted value). Lower pVO values were strongly associated with poorer survival regardless of whether patients were analyzed for absolute pVO in ml/kg/min, pVO ≤12 BB/14 ml/kg/min, or as a percentage of predicted pVO values (P ≤ 0.001 for all). For patients with pVO >12 BB/14 and ventilation/carbon dioxide relationship (VE/VCO) slope <35, the 1-year survival was 100%.

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

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http://dx.doi.org/10.1016/j.jchf.2021.05.021DOI Listing

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