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

Publication ,  Journal Article
Mirza, KK; Szymanski, MK; Schmidt, T; de Jonge, N; Brahmbhatt, DH; Billia, F; Hsu, S; MacGowan, GA; Jakovljevic, DG; Agostoni, P; Trombara, F ...
Published in: JACC Heart Fail
October 2021

OBJECTIVES: The purpose of this study was to examine whether peak oxygen uptake (pVO2) and other cardiopulmonary exercise test (CPET)-derived variables could predict intermediate-term mortality in stable continuous flow LVAD recipients. BACKGROUND: pVO2 is a cornerstone in the selection of patients for heart transplantation, but the prognostic power of pVO2 obtained in patients treated with a left ventricular assist device (LVAD) is unknown. METHODS: We collected data for pVO2 and outcomes in adult LVAD recipients in a retrospective, multicenter study and evaluated cutoff values for pVO2 including: 1) values above or below medians; 2) grouping patients in tertiles; and 3) pVO2 ≤14 ml/kg/min if the patient was not treated with beta-blockers (BB) or pVO2 ≤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/m2 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 pVO2 was 14.1 ± 5 ml/kg/min (47% ± 14% of predicted value). Lower pVO2 values were strongly associated with poorer survival regardless of whether patients were analyzed for absolute pVO2 in ml/kg/min, pVO2 ≤12 BB/14 ml/kg/min, or as a percentage of predicted pVO2 values (P ≤ 0.001 for all). For patients with pVO2 >12 BB/14 and ventilation/carbon dioxide relationship (VE/VCO2) slope <35, the 1-year survival was 100%. CONCLUSIONS: Even after LVAD implantation, pVO2 has prognostic value, similar to HF patients not supported by mechanical circulatory support devices. (PROgnostic Value of Exercise Capacity Measured as Peak Oxygen Uptake [pVO2] in Recipients of Left Ventricular Assist Devices [PRO-VAD]; NCT04423562).

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2021

Volume

9

Issue

10

Start / End Page

758 / 767

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prognosis
  • Oxygen Consumption
  • Oxygen
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Exercise Test
  • Adult
 

Citation

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Mirza, K. K., Szymanski, M. K., Schmidt, T., de Jonge, N., Brahmbhatt, D. H., Billia, F., … PRO-VAD Investigators, . (2021). Prognostic Value of Peak Oxygen Uptake in Patients Supported With Left Ventricular Assist Devices (PRO-VAD). JACC Heart Fail, 9(10), 758–767. https://doi.org/10.1016/j.jchf.2021.05.021
Mirza, Kiran K., Mariusz K. Szymanski, Thomas Schmidt, Nicolaas de Jonge, Darshan H. Brahmbhatt, Filio Billia, Steven Hsu, et al. “Prognostic Value of Peak Oxygen Uptake in Patients Supported With Left Ventricular Assist Devices (PRO-VAD).JACC Heart Fail 9, no. 10 (October 2021): 758–67. https://doi.org/10.1016/j.jchf.2021.05.021.
Mirza KK, Szymanski MK, Schmidt T, de Jonge N, Brahmbhatt DH, Billia F, et al. Prognostic Value of Peak Oxygen Uptake in Patients Supported With Left Ventricular Assist Devices (PRO-VAD). JACC Heart Fail. 2021 Oct;9(10):758–67.
Mirza, Kiran K., et al. “Prognostic Value of Peak Oxygen Uptake in Patients Supported With Left Ventricular Assist Devices (PRO-VAD).JACC Heart Fail, vol. 9, no. 10, Oct. 2021, pp. 758–67. Pubmed, doi:10.1016/j.jchf.2021.05.021.
Mirza KK, Szymanski MK, Schmidt T, de Jonge N, Brahmbhatt DH, Billia F, Hsu S, MacGowan GA, Jakovljevic DG, Agostoni P, Trombara F, Jorde U, Rochlani Y, Vandersmissen K, Reiss N, Russell SD, Meyns B, Gustafsson F, PRO-VAD Investigators. Prognostic Value of Peak Oxygen Uptake in Patients Supported With Left Ventricular Assist Devices (PRO-VAD). JACC Heart Fail. 2021 Oct;9(10):758–767.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2021

Volume

9

Issue

10

Start / End Page

758 / 767

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prognosis
  • Oxygen Consumption
  • Oxygen
  • Male
  • Humans
  • Heart-Assist Devices
  • Heart Failure
  • Exercise Test
  • Adult