title: Value of peak exercise oxygen consumption combined with B-type natriuretic peptide levels for optimal timing of cardiac transplantation.
abstract: BACKGROUND
  Peak exercise oxygen consumption (VO(2)) is widely used to select candidates for heart transplantation (HTx). However, the prognosis of patients with advanced heart failure and peak VO(2) of 10 to 14 mL/min per kg in the era of modern medical therapy for heart failure is not fully elucidated. B-type natriuretic peptide (BNP) is a useful prognostic marker in patients with heart failure.
  
  
  RESULTS
  A total of 424 patients undergoing HTx evaluation were classified according to peak VO(2) during cardiopulmonary exercise testing (>14, 10-14, and <10 mL/min per kg). Survival after cardiopulmonary exercise testing without HTx or ventricular assist device (VAD) support was compared with survival of 743 de novo HTx recipients. Multivariable analysis revealed that high BNP and low peak VO(2) were independently associated with death, HTx, or VAD requirements (hazard ratio, 3.5 and 0.6; 95% CI, 1.24-9.23 and 0.03-0.71; P=0.02 and <0.0001, respectively). VAD-free or HTx-free survival of patients with peak VO(2) 10 to 14 mL/min per kg was identical to post-HTx survival. When patients with peak VO(2) 10 to 14 mL/min per kg were dichotomized by a cutoff value of BNP of 506 pg/mL, those with BNP<506 pg/mL was equivalent to post-HTx survival (1 year: 90.8% versus 87.2%; P=0.61), whereas those with BNP≥506 showed worse VAD-free or HTx-free survival (1 year: 79.7%; P<0.001 versus post-HTx). Patients with peak VO(2) <10 mL/min per kg showed worse survival compared with post-HTx survival, and there was a survival difference between those with BNP≥506 and <506 pg/mL (1 year: 77.2% versus 56.1%; P=0.01).
  
  
  CONCLUSIONS
  Patients with peak VO(2) 10 to 14 mL/min per kg and low BNP levels have a VAD-free or HTx-free survival similar to post-HTx survival in heart recipients, whereas high BNP levels indicate worse outcome in this group of patients.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Elias
authors.initials: E
authors.lastname: Collado
authors.forename: Tuba
authors.initials: T
authors.lastname: Khawaja
authors.forename: Yumeko
authors.initials: Y
authors.lastname: Kawano
authors.forename: Margaret
authors.initials: M
authors.lastname: Kim
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
mesh_terms: D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009518:New York / Q000453:epidemiology; D010101:Oxygen Consumption / Q000502:physiology*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D020097:Natriuretic Peptide, Brain