Heart Failure, Morality, Transplant; Failure, Heart
Conditions
Keywords
advance heart failure, cardiac transplantation, Peak oxygen consumption, Guideline-directed medical therapy, Risk score, Heart Failure Survival Score
Brief summary
The ability and timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak VO2 by cardiopulmonary exercise test (CPET) was used for transplant listing. This study aimed to reassess the prognostic significance of peak VO2 and to compare that with the Heart Failure Survival Score in the current optimized novel guideline-directed medical therapy (GDMT).
Detailed description
Investigators retrospectively collected acute HF patients discharged alive from the hospital. Investigators divided participants into more-GDMT (≥2 kinds) and few-GDMT (\<2 kinds) groups and compared the prognostic significance of peak VO2 and HFSS for combined all-cause mortality and urgent cardiac transplantation.
Interventions
DIAGNOSTIC_TESTcardiopulmonary exercise test
CPET was performed in this HF cohort within one month after being discharged and interpreted as previously described. Patients underwent an upright graded cycle ergometer exercise using a personalized ramp protocol or a motorized treadmill using a modified Bruce or Cornell protocol. Peak VO2 data measured by cycle ergometer were increased by 10% to allow a comparison between the two different procedures. Peak VO2 was defined as the highest 30-second average value obtained during exercise. Submaximal CPET variables such as ventilatory efficiency were calculated by the slope of VE versus VCO2 below the ventilatory compensatory point (VCP). If the slope of VE/VCO2 can't be calculated, we used the nadir of VE/VCO2, or the ratio of VE/VCO2 at the anaerobic threshold (AT) as the variable of ventilatory efficiency. The AT was determined by the V-slope method.
Sponsors
Chang Gung Memorial Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* acute HF patients with reduced ejection fraction (left ventricular ejection fraction, LVEF \<=40%) and discharged alive from the hospital * patients with age \>= 20 years of age * patients who performed cardiopulmonary exercise test (CPET) within one month after discharge * patients with serum B-type natriuretic peptide (BNP) level \>100 pg/mL.
Exclusion criteria
* patients with estimated survival time \< 6 months * patients who could not tolerate exercise test due to muscular-skeletal disorder or other reason * patients who had severe valvular heart disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| all-cause mortality | May, 2014 ~ June 2020 | Number of participants that had occurrence of the mortality which is defined as all-cause mortality |
| urgent heart transplant | May, 2014 ~ June 2020 | Number of participants that had occurrence of the urgent heart transplant |
Countries
Taiwan
Outcome results
None listed