title: Is cardiopulmonary exercise testing essential to indicate ventricular assist device implantation in patients with INTERMACS profile 4-7?
abstract: Cardiopulmonary exercise testing (CPXT) is a promising tool for predicting 2-year cardiac death or ventricular assist device (VAD) implantation in patients assigned to INTERMACS profile 4-7. However, CPXT is not available in all hospitals. We evaluated 130 patients <65 years old with advanced heart failure assigned to INTERMACS profile 4-7 who underwent CPXT. CPXT scores (0-8 points), which we created recently, and the Seattle HF Model (SHFM) scores were both significant predictors of 2-year cardiac death or VAD implantation (14 events) by Cox-regression analysis (P < 0.05 for both) and had comparable areas under the curve (AUCs) in receiver operating characteristic analyses (0.811 vs. 0.737, P > 0.05). The combination score: age <46 years and serum sodium concentration <137 mEq/L, both of which were significant predictors of cardiac death or VAD implantation by uni/multivariate Cox-regression analyses, had a significantly higher AUC than did CPXT scores (0.909, P < 0.05). In a validation study, the AUC of the combination score was comparable with that of SHFM among 52 patients <65 years old receiving adaptive servo-ventilator treatment (0.753 vs. 0.794, P > 0.05). In conclusion, VAD indication may be discussed without CPXT in patients <65 years old with INTERMACS profile 4-7 at least in the current Japanese situation.
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. te.imamu@gmail.com.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.affiliation: Department of Internal Medicine II, Graduate School of Medicine and Pharmaceutical Sciences, Toyama University Hospital, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan. kinugawa-tky@umin.ac.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nitta
authors.affiliation: Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.affiliation: Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Nawata
authors.affiliation: Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000328:Adult; D000367:Age Factors; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012964:Sodium / Q000097:blood
chemical_list: D012964:Sodium
keywords: Cardiopulmonary exercise; Hyponatremia; Peak oxygen consumption