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Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival

Background: Decreased peak oxygen consumption during exercise (peak Vo(2)) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo(2) as a marker of post-transplant survival is not well established. Methods and Results: W...

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Autores principales: Hanff, Thomas C., Zhang, Yuhui, Zhang, Robert S., Genuardi, Michael V., Molina, Maria, McLean, Rhondalyn C., Mazurek, Jeremy A., Tanna, Monique S., Wald, Joyce W., Atluri, Pavan, Acker, Michael A., Goldberg, Lee R., Zamani, Payman, Birati, Edo Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821085/
https://www.ncbi.nlm.nih.gov/pubmed/36615166
http://dx.doi.org/10.3390/jcm12010366
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author Hanff, Thomas C.
Zhang, Yuhui
Zhang, Robert S.
Genuardi, Michael V.
Molina, Maria
McLean, Rhondalyn C.
Mazurek, Jeremy A.
Tanna, Monique S.
Wald, Joyce W.
Atluri, Pavan
Acker, Michael A.
Goldberg, Lee R.
Zamani, Payman
Birati, Edo Y.
author_facet Hanff, Thomas C.
Zhang, Yuhui
Zhang, Robert S.
Genuardi, Michael V.
Molina, Maria
McLean, Rhondalyn C.
Mazurek, Jeremy A.
Tanna, Monique S.
Wald, Joyce W.
Atluri, Pavan
Acker, Michael A.
Goldberg, Lee R.
Zamani, Payman
Birati, Edo Y.
author_sort Hanff, Thomas C.
collection PubMed
description Background: Decreased peak oxygen consumption during exercise (peak Vo(2)) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo(2) as a marker of post-transplant survival is not well established. Methods and Results: We performed a retrospective analysis of adult heart transplant recipients at the Hospital of the University of Pennsylvania who underwent cardiopulmonary exercise testing within a year of transplant between the years 2000 to 2011. Using time-to-event models, we analyzed the hazard of mortality over nearly two decades of follow-up as a function of post-transplant percent predicted peak Vo(2) (%Vo(2)). A total of 235 patients met inclusion criteria. The median post-transplant %Vo(2) was 49% (IQR 42 to 60). Each standard deviation (±14%) increase in %Vo(2) was associated with a 32% decrease in mortality in adjusted models (HR 0.68, 95% CI 0.53 to 0.87, p = 0.002). A %Vo(2) below 29%, 64% and 88% predicted less than 80% survival at 5, 10, and 15 years, respectively. Conclusions: Post-transplant peak Vo(2) is a highly significant prognostic marker for long-term post-transplant survival. It remains to be seen whether decreased peak Vo(2) post-transplant is modifiable as a target to improve post-transplant longevity.
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spelling pubmed-98210852023-01-07 Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival Hanff, Thomas C. Zhang, Yuhui Zhang, Robert S. Genuardi, Michael V. Molina, Maria McLean, Rhondalyn C. Mazurek, Jeremy A. Tanna, Monique S. Wald, Joyce W. Atluri, Pavan Acker, Michael A. Goldberg, Lee R. Zamani, Payman Birati, Edo Y. J Clin Med Article Background: Decreased peak oxygen consumption during exercise (peak Vo(2)) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo(2) as a marker of post-transplant survival is not well established. Methods and Results: We performed a retrospective analysis of adult heart transplant recipients at the Hospital of the University of Pennsylvania who underwent cardiopulmonary exercise testing within a year of transplant between the years 2000 to 2011. Using time-to-event models, we analyzed the hazard of mortality over nearly two decades of follow-up as a function of post-transplant percent predicted peak Vo(2) (%Vo(2)). A total of 235 patients met inclusion criteria. The median post-transplant %Vo(2) was 49% (IQR 42 to 60). Each standard deviation (±14%) increase in %Vo(2) was associated with a 32% decrease in mortality in adjusted models (HR 0.68, 95% CI 0.53 to 0.87, p = 0.002). A %Vo(2) below 29%, 64% and 88% predicted less than 80% survival at 5, 10, and 15 years, respectively. Conclusions: Post-transplant peak Vo(2) is a highly significant prognostic marker for long-term post-transplant survival. It remains to be seen whether decreased peak Vo(2) post-transplant is modifiable as a target to improve post-transplant longevity. MDPI 2023-01-03 /pmc/articles/PMC9821085/ /pubmed/36615166 http://dx.doi.org/10.3390/jcm12010366 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hanff, Thomas C.
Zhang, Yuhui
Zhang, Robert S.
Genuardi, Michael V.
Molina, Maria
McLean, Rhondalyn C.
Mazurek, Jeremy A.
Tanna, Monique S.
Wald, Joyce W.
Atluri, Pavan
Acker, Michael A.
Goldberg, Lee R.
Zamani, Payman
Birati, Edo Y.
Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival
title Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival
title_full Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival
title_fullStr Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival
title_full_unstemmed Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival
title_short Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival
title_sort early cardiopulmonary fitness after heart transplantation as a determinant of post-transplant survival
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821085/
https://www.ncbi.nlm.nih.gov/pubmed/36615166
http://dx.doi.org/10.3390/jcm12010366
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