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Observational Study
. 2014 Aug;20(8):548-54.
doi: 10.1016/j.cardfail.2014.05.008. Epub 2014 Jun 2.

Changes in cardiopulmonary exercise testing parameters following continuous flow left ventricular assist device implantation and heart transplantation

Shannon M Dunlay  1 , Thomas G Allison  2 , Naveen L Pereira  2
Affiliations
Observational Study

Changes in cardiopulmonary exercise testing parameters following continuous flow left ventricular assist device implantation and heart transplantation

Shannon M Dunlay et al. J Card Fail. 2014 Aug.

Abstract

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.

Keywords: Exercise capacity; heart transplantation; left ventricular assist device.

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Figures

Figure 1
Figure 1. Distribution of Exercise Time and Peak VO2 Before and After LVAD and Heart Transplant
The distribution of exercise time (Panel A) and peak VO2 (panel B) before and after LVAD (blue) and heart transplant (red) are shown
Figure 1
Figure 1. Distribution of Exercise Time and Peak VO2 Before and After LVAD and Heart Transplant
The distribution of exercise time (Panel A) and peak VO2 (panel B) before and after LVAD (blue) and heart transplant (red) are shown
Figure 2
Figure 2. Improvement in Cardiopulmonary Exercise Testing Following LVAD and Heart Transplant
The proportion of patients with improvement in exercise time, peak VO and VE/VCO2 post-LVAD (blue) and post-heart transplant (red) are shown
See this image and copyright information in PMC

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