Serial exercise testing and prognosis in selected patients considered for cardiac transplantation
Objectives This study sought to examine the predictive value of variables obtained from serial maximal exercise testing, echocardiography, and ejection fraction in patients referred as potential heart transplant candidates. Background Variables such as peak VO 2, left ventricular dimensions, ejectio...
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| Veröffentlicht in: | The American heart journal 1998-02, Vol.135 (2), p.221-229 |
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| creator | Gullestad, Lars Myers, Jonathan Ross, Heather Rickenbacher, Peter Slauson, Steven Bellin, Daniel Do, Dat Vagelos, Randall Fowler, Michael |
| description | Objectives This study sought to examine the predictive value of variables obtained from serial maximal exercise testing, echocardiography, and ejection fraction in patients referred as potential heart transplant candidates.
Background Variables such as peak VO
2, left ventricular dimensions, ejection fraction, and hemodynamic measurements are known to predict prognosis in heart failure, but there are few data on the impact of serial measurements of these variables on subsequent mortality.
Methods and Results Two hundred sixty-three ambulatory patients with severe heart failure referred as potential candidates for heart transplantation who underwent two exercise tests (mean 7.8 months apart) after optimal medical treatment were identified. At the same two time points, echocardiography was performed in 106 (37%) and ejection fraction was measured in 84 (30%). During a mean follow-up period of 3.9 ± 0.1 years, 70 (25%) died and 45 (19%) underwent heart transplantation. Exercise capacity, peak exercise heart rate, and peak exercise systolic blood pressure achieved were all significantly higher among survivors compared with nonsurvivors. Among the survivors a slight increase in peak VO
2 and ejection fraction were observed, but there were no significant differences in the changes of any of the measured variables between survivors and nonsurvivors. There were no significant differences in survival between patients with increased versus those with decreased peak VO
2, left ventricular dimensions, or ejection fraction.
Conclusion Although peak VO
2, left ventricular dimensions, and ejection fraction predict survival, changes in these parameters do not add any prognostic information in patients with severe heart failure who have been stabilized with optimal medical treatment. Routine use of these procedures therefore does not seem to be warranted and should be performed only in the context of a specific clinical situation. Serial measurements of these parameters do not appear to be useful in the risk stratification of patients referred for heart transplantation. (Am Heart J 1998;135:221-9.) |
| doi_str_mv | 10.1016/S0002-8703(98)70085-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_79711902</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002870398700857</els_id><sourcerecordid>79711902</sourcerecordid><originalsourceid>FETCH-LOGICAL-c436t-916a12fffd67f4c1c8a8bb7a150e65ad122b12ddc831085049762af2881958b83</originalsourceid><addsrcrecordid>eNqFkE1vEzEQhi0EKmnhJ1TyASE4LLWdXX-cEKqgVKrUQ-Fsee1xZbTxBs8G0X_PpIly5WR55hn7nYexSyk-SSH11YMQQnXWiPUHZz8aIezQmRdsJYUznTZ9_5KtTshrdo74i65aWX3GzlxvndN2xcIDtBImDn-hxYLAF8Cl1EceauLbNj_WGQvyUjnCBHEBqoalQF2Qx7liSdColufGY2iphMiXFipup1AXAuf6hr3KYUJ4ezwv2M9vX39cf-_u7m9ur7_cdbFf66VzUgepcs5Jm9xHGW2w42iCHAToISSp1ChVStGuJa0qeme0CllZK91gR7u-YO8P71Lq3zvawm8KRpgoCMw79MYZKZ1QBA4HMLYZsUH221Y2oT15KfxerX9W6_fevLP-Wa03NHd5_GA3biCdpo4uqf_u2A8Yw5RJAxk9YUoOlHiPfT5gQDL-FGgeI_mMkEojwT7N5T9B_gG_A5a2</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>79711902</pqid></control><display><type>article</type><title>Serial exercise testing and prognosis in selected patients considered for cardiac transplantation</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Gullestad, Lars ; Myers, Jonathan ; Ross, Heather ; Rickenbacher, Peter ; Slauson, Steven ; Bellin, Daniel ; Do, Dat ; Vagelos, Randall ; Fowler, Michael</creator><creatorcontrib>Gullestad, Lars ; Myers, Jonathan ; Ross, Heather ; Rickenbacher, Peter ; Slauson, Steven ; Bellin, Daniel ; Do, Dat ; Vagelos, Randall ; Fowler, Michael</creatorcontrib><description>Objectives This study sought to examine the predictive value of variables obtained from serial maximal exercise testing, echocardiography, and ejection fraction in patients referred as potential heart transplant candidates.
Background Variables such as peak VO
2, left ventricular dimensions, ejection fraction, and hemodynamic measurements are known to predict prognosis in heart failure, but there are few data on the impact of serial measurements of these variables on subsequent mortality.
Methods and Results Two hundred sixty-three ambulatory patients with severe heart failure referred as potential candidates for heart transplantation who underwent two exercise tests (mean 7.8 months apart) after optimal medical treatment were identified. At the same two time points, echocardiography was performed in 106 (37%) and ejection fraction was measured in 84 (30%). During a mean follow-up period of 3.9 ± 0.1 years, 70 (25%) died and 45 (19%) underwent heart transplantation. Exercise capacity, peak exercise heart rate, and peak exercise systolic blood pressure achieved were all significantly higher among survivors compared with nonsurvivors. Among the survivors a slight increase in peak VO
2 and ejection fraction were observed, but there were no significant differences in the changes of any of the measured variables between survivors and nonsurvivors. There were no significant differences in survival between patients with increased versus those with decreased peak VO
2, left ventricular dimensions, or ejection fraction.
Conclusion Although peak VO
2, left ventricular dimensions, and ejection fraction predict survival, changes in these parameters do not add any prognostic information in patients with severe heart failure who have been stabilized with optimal medical treatment. Routine use of these procedures therefore does not seem to be warranted and should be performed only in the context of a specific clinical situation. Serial measurements of these parameters do not appear to be useful in the risk stratification of patients referred for heart transplantation. (Am Heart J 1998;135:221-9.)</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/S0002-8703(98)70085-7</identifier><identifier>PMID: 9489968</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Case-Control Studies ; Cohort Studies ; Echocardiography ; Exercise Test - statistics & numerical data ; Female ; Follow-Up Studies ; Heart Failure - diagnosis ; Heart Failure - mortality ; Heart Failure - surgery ; Heart Transplantation - mortality ; Heart Transplantation - physiology ; Hemodynamics - physiology ; Humans ; Male ; Medical sciences ; Middle Aged ; Patient Selection ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Time Factors</subject><ispartof>The American heart journal, 1998-02, Vol.135 (2), p.221-229</ispartof><rights>1998 Mosby, Inc.</rights><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-916a12fffd67f4c1c8a8bb7a150e65ad122b12ddc831085049762af2881958b83</citedby><cites>FETCH-LOGICAL-c436t-916a12fffd67f4c1c8a8bb7a150e65ad122b12ddc831085049762af2881958b83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0002-8703(98)70085-7$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2157628$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9489968$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gullestad, Lars</creatorcontrib><creatorcontrib>Myers, Jonathan</creatorcontrib><creatorcontrib>Ross, Heather</creatorcontrib><creatorcontrib>Rickenbacher, Peter</creatorcontrib><creatorcontrib>Slauson, Steven</creatorcontrib><creatorcontrib>Bellin, Daniel</creatorcontrib><creatorcontrib>Do, Dat</creatorcontrib><creatorcontrib>Vagelos, Randall</creatorcontrib><creatorcontrib>Fowler, Michael</creatorcontrib><title>Serial exercise testing and prognosis in selected patients considered for cardiac transplantation</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Objectives This study sought to examine the predictive value of variables obtained from serial maximal exercise testing, echocardiography, and ejection fraction in patients referred as potential heart transplant candidates.
Background Variables such as peak VO
2, left ventricular dimensions, ejection fraction, and hemodynamic measurements are known to predict prognosis in heart failure, but there are few data on the impact of serial measurements of these variables on subsequent mortality.
Methods and Results Two hundred sixty-three ambulatory patients with severe heart failure referred as potential candidates for heart transplantation who underwent two exercise tests (mean 7.8 months apart) after optimal medical treatment were identified. At the same two time points, echocardiography was performed in 106 (37%) and ejection fraction was measured in 84 (30%). During a mean follow-up period of 3.9 ± 0.1 years, 70 (25%) died and 45 (19%) underwent heart transplantation. Exercise capacity, peak exercise heart rate, and peak exercise systolic blood pressure achieved were all significantly higher among survivors compared with nonsurvivors. Among the survivors a slight increase in peak VO
2 and ejection fraction were observed, but there were no significant differences in the changes of any of the measured variables between survivors and nonsurvivors. There were no significant differences in survival between patients with increased versus those with decreased peak VO
2, left ventricular dimensions, or ejection fraction.
Conclusion Although peak VO
2, left ventricular dimensions, and ejection fraction predict survival, changes in these parameters do not add any prognostic information in patients with severe heart failure who have been stabilized with optimal medical treatment. Routine use of these procedures therefore does not seem to be warranted and should be performed only in the context of a specific clinical situation. Serial measurements of these parameters do not appear to be useful in the risk stratification of patients referred for heart transplantation. (Am Heart J 1998;135:221-9.)</description><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Echocardiography</subject><subject>Exercise Test - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - surgery</subject><subject>Heart Transplantation - mortality</subject><subject>Heart Transplantation - physiology</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient Selection</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Time Factors</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1vEzEQhi0EKmnhJ1TyASE4LLWdXX-cEKqgVKrUQ-Fsee1xZbTxBs8G0X_PpIly5WR55hn7nYexSyk-SSH11YMQQnXWiPUHZz8aIezQmRdsJYUznTZ9_5KtTshrdo74i65aWX3GzlxvndN2xcIDtBImDn-hxYLAF8Cl1EceauLbNj_WGQvyUjnCBHEBqoalQF2Qx7liSdColufGY2iphMiXFipup1AXAuf6hr3KYUJ4ezwv2M9vX39cf-_u7m9ur7_cdbFf66VzUgepcs5Jm9xHGW2w42iCHAToISSp1ChVStGuJa0qeme0CllZK91gR7u-YO8P71Lq3zvawm8KRpgoCMw79MYZKZ1QBA4HMLYZsUH221Y2oT15KfxerX9W6_fevLP-Wa03NHd5_GA3biCdpo4uqf_u2A8Yw5RJAxk9YUoOlHiPfT5gQDL-FGgeI_mMkEojwT7N5T9B_gG_A5a2</recordid><startdate>19980201</startdate><enddate>19980201</enddate><creator>Gullestad, Lars</creator><creator>Myers, Jonathan</creator><creator>Ross, Heather</creator><creator>Rickenbacher, Peter</creator><creator>Slauson, Steven</creator><creator>Bellin, Daniel</creator><creator>Do, Dat</creator><creator>Vagelos, Randall</creator><creator>Fowler, Michael</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19980201</creationdate><title>Serial exercise testing and prognosis in selected patients considered for cardiac transplantation</title><author>Gullestad, Lars ; Myers, Jonathan ; Ross, Heather ; Rickenbacher, Peter ; Slauson, Steven ; Bellin, Daniel ; Do, Dat ; Vagelos, Randall ; Fowler, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-916a12fffd67f4c1c8a8bb7a150e65ad122b12ddc831085049762af2881958b83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Echocardiography</topic><topic>Exercise Test - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - surgery</topic><topic>Heart Transplantation - mortality</topic><topic>Heart Transplantation - physiology</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patient Selection</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gullestad, Lars</creatorcontrib><creatorcontrib>Myers, Jonathan</creatorcontrib><creatorcontrib>Ross, Heather</creatorcontrib><creatorcontrib>Rickenbacher, Peter</creatorcontrib><creatorcontrib>Slauson, Steven</creatorcontrib><creatorcontrib>Bellin, Daniel</creatorcontrib><creatorcontrib>Do, Dat</creatorcontrib><creatorcontrib>Vagelos, Randall</creatorcontrib><creatorcontrib>Fowler, Michael</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gullestad, Lars</au><au>Myers, Jonathan</au><au>Ross, Heather</au><au>Rickenbacher, Peter</au><au>Slauson, Steven</au><au>Bellin, Daniel</au><au>Do, Dat</au><au>Vagelos, Randall</au><au>Fowler, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serial exercise testing and prognosis in selected patients considered for cardiac transplantation</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>1998-02-01</date><risdate>1998</risdate><volume>135</volume><issue>2</issue><spage>221</spage><epage>229</epage><pages>221-229</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Objectives This study sought to examine the predictive value of variables obtained from serial maximal exercise testing, echocardiography, and ejection fraction in patients referred as potential heart transplant candidates.
Background Variables such as peak VO
2, left ventricular dimensions, ejection fraction, and hemodynamic measurements are known to predict prognosis in heart failure, but there are few data on the impact of serial measurements of these variables on subsequent mortality.
Methods and Results Two hundred sixty-three ambulatory patients with severe heart failure referred as potential candidates for heart transplantation who underwent two exercise tests (mean 7.8 months apart) after optimal medical treatment were identified. At the same two time points, echocardiography was performed in 106 (37%) and ejection fraction was measured in 84 (30%). During a mean follow-up period of 3.9 ± 0.1 years, 70 (25%) died and 45 (19%) underwent heart transplantation. Exercise capacity, peak exercise heart rate, and peak exercise systolic blood pressure achieved were all significantly higher among survivors compared with nonsurvivors. Among the survivors a slight increase in peak VO
2 and ejection fraction were observed, but there were no significant differences in the changes of any of the measured variables between survivors and nonsurvivors. There were no significant differences in survival between patients with increased versus those with decreased peak VO
2, left ventricular dimensions, or ejection fraction.
Conclusion Although peak VO
2, left ventricular dimensions, and ejection fraction predict survival, changes in these parameters do not add any prognostic information in patients with severe heart failure who have been stabilized with optimal medical treatment. Routine use of these procedures therefore does not seem to be warranted and should be performed only in the context of a specific clinical situation. Serial measurements of these parameters do not appear to be useful in the risk stratification of patients referred for heart transplantation. (Am Heart J 1998;135:221-9.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>9489968</pmid><doi>10.1016/S0002-8703(98)70085-7</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Case-Control Studies Cohort Studies Echocardiography Exercise Test - statistics & numerical data Female Follow-Up Studies Heart Failure - diagnosis Heart Failure - mortality Heart Failure - surgery Heart Transplantation - mortality Heart Transplantation - physiology Hemodynamics - physiology Humans Male Medical sciences Middle Aged Patient Selection Predictive Value of Tests Prognosis Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Time Factors |
| title | Serial exercise testing and prognosis in selected patients considered for cardiac transplantation |
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