Prognostic Value of Pre-Transplant Peak Oxygen Consumption on Post-Transplant Survival: ISHLT Registry Analysis

Purpose Cardiopulmonary exercise testing provides an integrative assessment of multiorgan physiological response to exercise involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems. The predictive value of peak ventilatory oxygen consumption (maxVo2) in optimizing the timing of heart transplantation (HT) is well established, but its prognostic value for HT outcomes is not known. We aimed to study the predictive role of pre-HT maxVo2 for 1-month and 1-year mortality after HT. Methods We performed an analysis of adult HT recipients in the ISHLT Registry transplanted between 1996 and 2017. Recipients were stratified into quartiles by pre-HT maxVo2. Using multivariable regression modelling we assessed the associations of maxVo2 with 1-month post-transplant mortality and 1-year post-transplant mortality conditional on survival to 1 month. Results Among 12,606 recipients, 26% were women. Median maxVo2 was lower in women (11.5 mL/kg/min [IQR 9,13]) vs men (12.0 mL/kg/min [IQR 10,14], p Conclusion Beyond its key application for prognosis in heart failure and determination of candidacy for HT, maxVo2 has a predictive value for post-HT survival. Patients in the highest maxVo2 quartile are at the lowest risk of 1-month mortality, suggesting perioperative advantage for patients with less functional limitation. More importantly, pre-transplant maxVo2 impairment across the 4 quartiles is associated with risk of mortality between 1-month and 1-year. Whether this risk can be modified by cardiac rehabilitation and physical therapy programs individualized by pre-transplant maxVo2 should be investigated.