Risk stratification of ambulatory patients with advanced heart failure undergoing evaluation for heart transplantation
Section snippets
Study design
We retrospectively analyzed 151 Stage C/D, New York Heart Association (NYHA) Class III ambulatory HF patients who presented to our institution for HTx evaluation between February 2007 and May 2010. Patients were included if they were able to perform an exercise test and had undergone transthoracic echocardiogram, right heart catheterization and laboratory testing within a time-frame of 30 days. In addition, all patients were on maximal medical therapy and resynchronization therapy and/or a
Baseline characteristics and patients outcome within 1 year after evaluation
The clinical characteristics of the patients studied are summarized in Table 1. The mean age of the patients was 55 years, 79% were male and 39% patients had ischemic heart disease. We were able to obtain detailed information about medications from 90% of patients and from 100% with regard to device therapy. Among these, 93% patients were on β-blocker therapy and 57% patients received cardiac resynchronization therapy. Mean peak VO2 at the time of HTx evaluation was 12.5 ml/kg/min, and the mean
Disclosure statement
The authors have no conflicts of interest to disclose.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
The first and second authors (T.S.K. and G.R.S.) contributed equally to this work. M.F. was supported by the National Center for Advancing Translational Sciences (UL1 RR024156), formerly the National Center for Research Resources, of the National Institutes of Health (UL1 TR000040).
References (32)
- et al.
The registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult heart transplant report—2011
J Heart Lung Transplant
(2011) - et al.
Cardiac transplant outcome of patients supported on left ventricular assist device vs. intravenous inotropic therapy
J Heart Lung Transplant
(2001) - et al.
Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006
J Heart Lung Transplant
(2006) - et al.
Predicting survival in ambulatory patients with severe heart failure on beta-blocker therapy
Am J Cardiol
(2003) - et al.
Cardiopulmonary exercise testing and prognosis in severe heart failure: 14 mL/min/kg revisited
Am Heart J
(2000) - et al.
Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction
J Am Coll Cardiol
(2012) - et al.
Exercise intolerance in heart failure with preserved ejection fraction: shifting focus from the heart to peripheral skeletal muscle
J Am Coll Cardiol
(2012) - et al.
A multicenter study of noninvasive cardiac output during symptom limited exercise
J Card Fail
(2009) - et al.
Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction
J Heart Lung Transplant
(2012) - et al.
The fourth INTERMACS annual report: 4,000 implants and counting
J Heart Lung Transplant
(2012)
Validation of peak exercise oxygen consumption and the Heart Failure Survival Score for serial risk stratification in advanced heart failure
Am J Cardiol
Comparison of peak exercise oxygen consumption and the Heart Failure Survival Score for predicting prognosis in women versus men
Am J Cardiol
Selecting patients for heart transplantation: comparison of the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM)
J Heart Lung Transplant
Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure
J Am Coll Cardiol
Markers of extracellular matrix turnover and the development of right ventricular failure after ventricular assist device implantation in patients with advanced heart failure
J Heart Lung Transplant
A model to predict survival in patients with end-stage liver disease
Hepatology
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