[Ironman and cardiac transplantation. High sporting exercise capacity before and after cardiac transplantation]

The case of a 45-year-old man is reported who was an active competitive sportsman up to his 38th year. In fall of 1998, exercise limitation was noted. The cardiologic work-up revealed dilated cardiomyopathy. In spite of intensive medical therapy clinical course deteriorated within the next 3 years, cardiologic findings and a follow-up in CPET (cardiopulmonary exercise testing) showed a rapid decline. In May 2002, he was listed for cardiac transplantation. In August 2003, an orthotopic bicaval cardiac transplantation was performed at the University of Göttingen, Germany. The patient was followed regularly in the office. Physical exercise capacity increased significantly and he was able to participate in the 10-km New Year's run of 2003. Since 2004, he has been working very successfully as a coach for competitive swimmers. Based on CPET findings, actual views and concepts regarding the pathophysiology and training of chronic heart failure are discussed and the question is raised whether and in which respect a sportive predisposition favors the clinical outcome.