Clinical features and determinants of VO2peak in de novo heart transplant recipients

Katrine Rolid, Arne K Andreassen, Marianne Yardley, Elisabeth Bjørkelund, Kristjan Karason, Julia P Wigh, Christian H Dall, Finn Gustafsson, Lars Gullestad, Kari Nytrøen, Katrine Rolid, Arne K Andreassen, Marianne Yardley, Elisabeth Bjørkelund, Kristjan Karason, Julia P Wigh, Christian H Dall, Finn Gustafsson, Lars Gullestad, Kari Nytrøen

Abstract

Aim: To study exercise capacity and determinants of early peak oxygen consumption (VO2peak) in a cohort of de novo heart transplant (HTx) recipients.

Methods: To determine possible central (chronotropic responses, cardiopulmonary and hemodynamic function) and peripheral factors (muscular exercise capacity and body composition) predictive of VO2peak, a number of different measurements and tests were performed, as follows: Cardiopulmonary exercise testing (CPET) was performed mean 11 wk after surgery in 81 HTx recipients > 18 years and was measured with breath by breath gas exchange on a treadmill or bicycle ergometer. Metabolic/respiratory measures include VO2peak and VE/VCO2 slope. Additional measures included muscle strength testing, bioelectrical impedance analysis, echocardiography, blood sampling and health-related quality of life. Based on the VO2peak (mL/kg per minute) median value, the study population was divided into two groups defined as a low-capacity group and a high-capacity group. Potential predictors were analyzed using multiple regression analysis with VO2peak (L/min) as the dependent variable.

Results: The mean ± standard deviation (SD) age of the total study population was 49 ± 13 years, and 73% were men. This de novo HTx cohort demonstrated a median VO2peak level of 19.4 mL/kg per min at 11 ± 1.8 wk post-HTx. As compared with the high-capacity group, the low-capacity group exercised for a shorter time, had lower maximal ventilation, O2 pulse, peak heart rate and heart rate reserve, while the VE/VCO2 slope was higher. The low-capacity group had less muscle strength and muscular exercise capacity in comparison with the high-capacity group. In order of importance, O2 pulse, heart rate reserve, muscular exercise capacity, body mass index, gender and age accounted for 84% of the variance in VO2peak (L/min). There were no minor or major serious adverse events during the CPET.

Conclusion: Although there is great individual variance among de novo HTx recipients, early VO2peak measures appear to be influenced by both central and peripheral factors.

Keywords: Cardiopulmonary exercise testing; De novo heart transplant; Early VO2peak; Health related quality of life; Muscle strength.

Conflict of interest statement

Conflict-of-interest statement: None of the authors have any conflict of interest to declare.

Figures

Figure 1
Figure 1
Scatterplot of the correlation between peak oxygen consumption (L/min) and heart rate reserve with inserted regression line. R2 = 0.224. Pearsons r 0.473, P < 0.001. VO2peak: Peak oxygen consumption; HRreserve: Heart rate reserve.
Figure 2
Figure 2
Scatterplot of the correlation between peak oxygen consumption (L/min) and O2 pulse with inserted regression line. R2 = 0.647. Pearsons r 0.804, P < 0.001. VO2peak: Peak oxygen consumption.
Figure 3
Figure 3
Scatterplot of the correlation between peak oxygen consumption (L/min) and muscular exercise capacity (Joule) with inserted regression line. R2 = 0.406. Pearsons r 0.637, P < 0.001. VO2peak: Peak oxygen consumption.

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