Serial Exercise Testing and Prognosis in Selected Patients
Considered for Cardiac Transplantation

From American Heart Journal

	We studied the predictive value of measurements from
serial exercise testing, echocardiography, and ejection
fraction in potential heart transplant candidates. Peak VO2,
left ventricular dimensions, ejection fraction, and
hemodynamic measurements are known to predict prognosis in
heart failure, but there is little info on the impact of
serial measurements on mortality prediction.
	263 ambulatory patients with severe heart failure
referred for heart transplant took 2 exercise tests an average
of 8 months apart. At the same 2 time points, echo was done
in 106 (37%) and ejection fraction was measured in 84 (30%).
During a 4 year follow-up, 25% died and 19% had a heart
transplant.
	Exercise capacity, peak exercise heart rate, and
peak exercise systolic blood pressure were all higher among
survivors compared with nonsurvivors. Among the survivors a
slight increase in peak VO2 and EF were seen, but there were
no significant differences in the changes of any of the
measured areas between survivors and nonsurvivors.
	CONCLUSION: Although peak VO2, left ventricular
dimensions, and ejection fraction predict survival, changes
in these measurements do not have any prognostic value in
patients with severe heart failure who have been stabilized
with drug treatment. Routine use of these procedures does not
seem necessary. Serial measurements of these values does not
seem useful in defining risk in patients referred for heart
transplant.

Am Heart J 135(2):221-229, 1998