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Objective Spleen volume increases in patients with advanced heart failure (HF) after left ventricular assist device (LVAD) implantation. However, the relationship between spleen volume and exercise tolerance (peak oxygen consumption [VO 2 ]) in these patients remains unknown. In this exploratory study, we enrolled 27 patients with HF using a LVAD (median age: 46 years). Patients underwent blood testing, echocardiography, right heart catheterization, computed tomography (CT), and cardiopulmonary exercise testing. Spleen size was measured using CT volumetry, and the correlations/causal relationships of factors affecting peak VO 2  were identified using structural equation modeling. Results The median spleen volume was 190.0 mL, and peak VO 2  was 13.2 mL/kg/min. The factors affecting peak VO 2  were peak heart rate (HR; β = 0.402,  P  = .015), pulmonary capillary wedge pressure (PCWP; β =  − 0.698,  P  = .014), right ventricular stroke work index (β = 0.533,  P  = .001), blood hemoglobin concentration (β = 0.359,  P  = .007), and spleen volume (β = 0.215,  P  = .041). Spleen volume correlated with peak HR, PCWP, and hemoglobin concentration, reflecting sympathetic activity, cardiac preload, and oxygen-carrying capacity, respectively, and was thus related to peak VO 2 . These results suggest an association between spleen volume and exercise tolerance in advanced HF.

Relationship between spleen size and exercise tolerance in advanced heart failure patients with a left ventricular assist device