SEX AND LEFT-VENTRICULAR VOLUME PREDICT SURVIVAL IN HEART-TRANSPLANT CANDIDATES WITH PEAK OXYGEN-UPTAKE BETWEEN 10 AND 14 MILLILITERS PER KILOGRAM PER MINUTE

Background: The purpose of this study was to identify predictors of su rvival in patients referred for heart transplantation evaluation who h ad a peak oxygen uptake of 10 to 14 ml/kg/min measured during initial cardiopulmonary exercise testing. Methods: Seventy-two patients were i dentified retrospectively from a database of 304 patients who underwen t heart transplantation evaluations at our center from 1985 to 1995. A ll 72 patients underwent right-sided heart catheterization and first-p ass right and left ventricular radionuclide ventriculography during ca rdiopulmonary exercise testing. Results: There were 14 women and 58 me n in the study (mean age 52 +/- 9 years, 80% male, 79% New York Heart Association class III/IV, left ventricular ejection fraction of 0.24 /- 0.9, and left ventricular end-diastolic volume index of 144 +/- 59 mi). During a mean follow-up of 19 +/- 23 months, two women and 32 men (47%) reached the combined end point of death (n = 20) or pretranspla ntation admission for inotropic or mechanical support (n 14). For the entire cohort, analysis of clinical, ventriculographic, and exercise p arameters identified female sex, younger age, and age/ sex-adjusted pe ak oxygen uptake as independent predictors of survival. In men only, a ge, left ventricular end-diastolic volume index, and age/sex adjusted peak oxygen uptake were independent predictors of survival. Conclusion s: Among patients referred for heart transplantation evaluation with a peak oxygen uptake between 10 to 14 ml/kg/min, younger age, female se x, and higher age/sex-adjusted peak oxygen uptake predict longer survi val to the combined end point of death or pretransplantation admission for inotropic or mechanical support. These measures may be useful in additional risk stratification of such patients.