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Article

Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival

by
Thomas C. Hanff
1,*,
Yuhui Zhang
2,
Robert S. Zhang
3,
Michael V. Genuardi
1,
Maria Molina
1,
Rhondalyn C. McLean
1,
Jeremy A. Mazurek
1,
Monique S. Tanna
1,
Joyce W. Wald
1,
Pavan Atluri
4,
Michael A. Acker
4,
Lee R. Goldberg
1,
Payman Zamani
1 and
Edo Y. Birati
1,5
1
Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
2
Fuwai Hospital, Peking Union Medical College, Beijing 100006, China
3
Division of Cardiovascular Medicine, NYU Langone Health, New York, NY 10016, USA
4
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
5
The Lydia and Carol Kittner, Lea and Banjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh-Poriya Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan 5290002, Israel
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(1), 366; https://doi.org/10.3390/jcm12010366
Submission received: 4 December 2022 / Revised: 28 December 2022 / Accepted: 29 December 2022 / Published: 3 January 2023
(This article belongs to the Section Cardiology)
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Abstract

Background: Decreased peak oxygen consumption during exercise (peak Vo2) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo2 as a marker of post-transplant survival is not well established. Methods and Results: We performed a retrospective analysis of adult heart transplant recipients at the Hospital of the University of Pennsylvania who underwent cardiopulmonary exercise testing within a year of transplant between the years 2000 to 2011. Using time-to-event models, we analyzed the hazard of mortality over nearly two decades of follow-up as a function of post-transplant percent predicted peak Vo2 (%Vo2). A total of 235 patients met inclusion criteria. The median post-transplant %Vo2 was 49% (IQR 42 to 60). Each standard deviation (±14%) increase in %Vo2 was associated with a 32% decrease in mortality in adjusted models (HR 0.68, 95% CI 0.53 to 0.87, p = 0.002). A %Vo2 below 29%, 64% and 88% predicted less than 80% survival at 5, 10, and 15 years, respectively. Conclusions: Post-transplant peak Vo2 is a highly significant prognostic marker for long-term post-transplant survival. It remains to be seen whether decreased peak Vo2 post-transplant is modifiable as a target to improve post-transplant longevity.
Keywords: transplant; exercise; survival; prognosis transplant; exercise; survival; prognosis

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MDPI and ACS Style

Hanff, T.C.; Zhang, Y.; Zhang, R.S.; Genuardi, M.V.; Molina, M.; McLean, R.C.; Mazurek, J.A.; Tanna, M.S.; Wald, J.W.; Atluri, P.; et al. Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival. J. Clin. Med. 2023, 12, 366. https://doi.org/10.3390/jcm12010366

AMA Style

Hanff TC, Zhang Y, Zhang RS, Genuardi MV, Molina M, McLean RC, Mazurek JA, Tanna MS, Wald JW, Atluri P, et al. Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival. Journal of Clinical Medicine. 2023; 12(1):366. https://doi.org/10.3390/jcm12010366

Chicago/Turabian Style

Hanff, Thomas C., Yuhui Zhang, Robert S. Zhang, Michael V. Genuardi, Maria Molina, Rhondalyn C. McLean, Jeremy A. Mazurek, Monique S. Tanna, Joyce W. Wald, Pavan Atluri, and et al. 2023. "Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival" Journal of Clinical Medicine 12, no. 1: 366. https://doi.org/10.3390/jcm12010366

APA Style

Hanff, T. C., Zhang, Y., Zhang, R. S., Genuardi, M. V., Molina, M., McLean, R. C., Mazurek, J. A., Tanna, M. S., Wald, J. W., Atluri, P., Acker, M. A., Goldberg, L. R., Zamani, P., & Birati, E. Y. (2023). Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival. Journal of Clinical Medicine, 12(1), 366. https://doi.org/10.3390/jcm12010366

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