title: Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation.
abstract: OBJECTIVE
  The 3-year survival rates of 500 patients with congestive heart failure (CHF) referred for heart transplantation were assessed to evaluate the clinical and exercise variables most useful for estimating prognostic risk.
  
  
  BACKGROUND
  Detailed prognostic risk stratification of patients with a peak exercise oxygen consumption (VO2) < or = 14 ml/min per kg to identify lower risk patient subsets has been limited in earlier series by relatively small sample size.
  
  
  METHODS
  Cardiopulmonary exercise testing was performed in 500 patients with CHF referred for heart transplantation; 154 (31%) had a peak exercise VO2 < or = 14 ml/min per kg. Univariate and multivariate analyses were performed to identify the 3-year prognostic risk.
  
  
  RESULTS
  The 55% 3-year survival rate of the 77 patients with a peak exercise VO2 < or = 14 ml/min per kg unable to reach a peak exercise systolic blood pressure (SBP) of 120 mm Hg was significantly lower than the 83% survival rate in the 74 patients able to reach this exercise blood pressure (p = 0.004). Multivariate analysis revealed that peak exercise SBP (p = 0.0005) and percent predicted peak VO2 < or = 50% (p = 0.04) were the two most important predictors for the combined end point of death or listing as Status 1.
  
  
  CONCLUSIONS
  Peak exercise SBP and percent predicted peak exercise VO2 are two inexpensive and easily measured noninvasive variables that can be used to further prognostically risk stratify ambulatory patients with CHF referred for heart transplantation with a peak exercise VO2 < or = 14 ml/min per kg.
authors.affiliation: Department of Medicine, Saint Louis University School of Medicine, Missouri, USA.
authors.forename: N
authors.initials: N
authors.lastname: Osada
authors.forename: B R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: L W
authors.initials: LW
authors.lastname: Miller
authors.forename: D
authors.initials: D
authors.lastname: Yip
authors.forename: M B
authors.initials: MB
authors.lastname: Cishek
authors.forename: T L
authors.initials: TL
authors.lastname: Wolford
authors.forename: T J
authors.initials: TJ
authors.lastname: Donohue
mesh_terms: D000328:Adult; D015986:Confounding Factors, Epidemiologic; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis