TY - JOUR
T1 - Changes in cardiopulmonary exercise testing parameters following continuous flow left ventricular assist device implantation and heart transplantation
AU - Dunlay, Shannon M.
AU - Allison, Thomas G.
AU - Pereira, Naveen L.
N1 - Funding Information:
Dr. Dunlay is funded by a National Institutes of Health Career Development Award ( K23HL 116643 ). Dr. Pereira is funded by a grant from the National Center for Advancing Translational Sciences , United States ( UL1 TR000135 ).
PY - 2014/8
Y1 - 2014/8
N2 - Background Reduced exercise tolerance from impaired cardiac output is an important criterion for left ventricular assist device (LVAD) implantation. However, little is known about how exercise capacity changes after LVAD and how changes compare with patients undergoing heart transplantation. Methods and Results We compared changes in cardiopulmonary exercise testing performed pre- and postoperatively in patients who underwent HeartMate II LVAD implantation (n = 25) and heart transplantation (n = 74) at the Mayo Clinic in Rochester, Minnesota, between 2007 and 2012. Preoperatively, patients undergoing LVAD and transplant had markedly reduced exercise time (mean 5.1 minutes [45% predicted] and 5.0 minutes [44% predicted], respectively), low peak oxygen consumption (VO2; mean 11.5 mL·kg·min [43% predicted] and 11.9 mL·kg·min [38% predicted]), and abnormal ventilatory gas exchange (ratio of minute ventilation to carbon dioxide production [VE/VCO2] nadir 39.4 and 37.4). After LVAD and transplant, there were similar improvements in exercise time (mean Δ +1.2 vs. 1.7 minutes, respectively, P =.27) and VE/VCO2 nadir (mean Δ -3.7 vs. -4.2, P =.74). However, peak VO2 increased posttransplant but did not change post-LVAD (mean Δ +5.4 vs. +0.9 mL·kg·min, respectively, P <.001). Most patients (72%) had a peak VO2 < 14 mL·kg·min post-LVAD. Conclusions Although improvements in exercise capacity and gas exchange are seen after LVAD and heart transplant, peak VO2 doesn't improve post-LVAD and remains markedly abnormal in most patients.
AB - Background Reduced exercise tolerance from impaired cardiac output is an important criterion for left ventricular assist device (LVAD) implantation. However, little is known about how exercise capacity changes after LVAD and how changes compare with patients undergoing heart transplantation. Methods and Results We compared changes in cardiopulmonary exercise testing performed pre- and postoperatively in patients who underwent HeartMate II LVAD implantation (n = 25) and heart transplantation (n = 74) at the Mayo Clinic in Rochester, Minnesota, between 2007 and 2012. Preoperatively, patients undergoing LVAD and transplant had markedly reduced exercise time (mean 5.1 minutes [45% predicted] and 5.0 minutes [44% predicted], respectively), low peak oxygen consumption (VO2; mean 11.5 mL·kg·min [43% predicted] and 11.9 mL·kg·min [38% predicted]), and abnormal ventilatory gas exchange (ratio of minute ventilation to carbon dioxide production [VE/VCO2] nadir 39.4 and 37.4). After LVAD and transplant, there were similar improvements in exercise time (mean Δ +1.2 vs. 1.7 minutes, respectively, P =.27) and VE/VCO2 nadir (mean Δ -3.7 vs. -4.2, P =.74). However, peak VO2 increased posttransplant but did not change post-LVAD (mean Δ +5.4 vs. +0.9 mL·kg·min, respectively, P <.001). Most patients (72%) had a peak VO2 < 14 mL·kg·min post-LVAD. Conclusions Although improvements in exercise capacity and gas exchange are seen after LVAD and heart transplant, peak VO2 doesn't improve post-LVAD and remains markedly abnormal in most patients.
KW - Exercise capacity
KW - heart transplantation
KW - left ventricular assist device
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U2 - 10.1016/j.cardfail.2014.05.008
DO - 10.1016/j.cardfail.2014.05.008
M3 - Article
C2 - 24893345
AN - SCOPUS:84905508957
SN - 1071-9164
VL - 20
SP - 548
EP - 554
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 8
ER -