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Is cardiopulmonary exercise testing essential to indicate ventricular assist device implantation in patients with INTERMACS profile 4–7?

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  • Artificial Heart (Clinical)
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Abstract

Cardiopulmonary exercise testing (CPXT) is a promising tool for predicting 2-year cardiac death or ventricular assist device (VAD) implantation in patients assigned to INTERMACS profile 4–7. However, CPXT is not available in all hospitals. We evaluated 130 patients <65 years old with advanced heart failure assigned to INTERMACS profile 4–7 who underwent CPXT. CPXT scores (0–8 points), which we created recently, and the Seattle HF Model (SHFM) scores were both significant predictors of 2-year cardiac death or VAD implantation (14 events) by Cox-regression analysis (P < 0.05 for both) and had comparable areas under the curve (AUCs) in receiver operating characteristic analyses (0.811 vs. 0.737, P > 0.05). The combination score: age <46 years and serum sodium concentration <137 mEq/L, both of which were significant predictors of cardiac death or VAD implantation by uni/multivariate Cox-regression analyses, had a significantly higher AUC than did CPXT scores (0.909, P < 0.05). In a validation study, the AUC of the combination score was comparable with that of SHFM among 52 patients <65 years old receiving adaptive servo-ventilator treatment (0.753 vs. 0.794, P > 0.05). In conclusion, VAD indication may be discussed without CPXT in patients <65 years old with INTERMACS profile 4–7 at least in the current Japanese situation.

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Authors and Affiliations

  1. Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Teruhiko Imamura

  2. Department of Internal Medicine II, Graduate School of Medicine and Pharmaceutical Sciences, Toyama University Hospital, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan

    Koichiro Kinugawa

  3. Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Daisuke Nitta

  4. Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Osamu Kinoshita, Kan Nawata & Minoru Ono

Authors
  1. Teruhiko Imamura
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  2. Koichiro Kinugawa
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  3. Daisuke Nitta
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  4. Osamu Kinoshita
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  5. Kan Nawata
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  6. Minoru Ono
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Correspondence to Teruhiko Imamura or Koichiro Kinugawa.

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Imamura, T., Kinugawa, K., Nitta, D. et al. Is cardiopulmonary exercise testing essential to indicate ventricular assist device implantation in patients with INTERMACS profile 4–7?. J Artif Organs 19, 226–232 (2016). https://doi.org/10.1007/s10047-016-0893-x

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  • DOI: https://doi.org/10.1007/s10047-016-0893-x

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