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Changes in exercise capacity induced by heart transplantation: prognostic and therapeutic implications
Author(s) -
Grigioni F.,
Specchia S.,
Maietta P.,
Potena L.,
BacchiReggiani M. L.,
Ghetti G.,
Boriani G.,
Foschi E.,
Corazza I.,
Ionico T.,
Magnani G.,
Zannoli R.,
Tentoni C.,
Branzi A.
Publication year - 2011
Publication title -
scandinavian journal of medicine and science in sports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.575
H-Index - 115
eISSN - 1600-0838
pISSN - 0905-7188
DOI - 10.1111/j.1600-0838.2009.01065.x
Subject(s) - medicine , hazard ratio , body mass index , heart failure , vo2 max , cardiology , odds ratio , heart transplantation , transplantation , physical therapy , prospective cohort study , lung transplantation , confidence interval , heart rate , blood pressure
Survival and exercise performance are key targets of heart transplantation (HT). We designed this study to help in identifying (1) patients with chronic heart failure (CHF) at risk of poor exercise capacity after HT and (2) HT recipients presenting risk factors modifiable with exercise showing a potential impact on outcome. We enrolled 49 HT recipients (age 52 ± 12 years, 84% males) who underwent a cardiopulmonary exercise test before (9 ± 6 months) and after (20 ± 14 months) HT. In the CHF phase, lower peak oxygen consumption (V̇O 2 ) (odds ratio 0.69, P =0.017) independently predicted peak V̇O 2 improvement after HT. In the post‐HT phase, body mass index (BMI) [adjusted hazard ratio (HR) 1.16, P =0.034] and V̇E (ventilation)/V̇CO 2 (carbon dioxide production) slope (adjusted HR 1.07, P =0.031) independently predicted mortality. In conclusion, CHF patients with only a moderate impairment of peak V̇O 2 are at a risk of failing to achieve a significant improvement of exercise performance after HT. In the post‐HT phase, a BMI≥28 and/or a V̇E/V̇CO 2 slope ≥47 represent risk factors for death, which are potentially modifiable with exercise. Prospective randomized studies are needed to analyze the effects of training on functional capacity and outcome in the different subsets of HT recipients.