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Novel scoring system using postoperative cardiopulmonary exercise testing predicts future explantation of left
Teruhiko Imamura1, Koichiro Kinugawa, Daisuke Nitta
1Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo.
Insights
Cardiopulmonary exercise (CPX) testing can predict left ventricular assist device (LVAD) explantation. A simple explantation score from CPX results helps identify patients suitable for device removal.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Exercise Physiology
Background:
- Cardiopulmonary exercise (CPX) testing is vital for predicting survival in heart failure (HF) patients.
- The prognostic value of CPX testing for left ventricular assist device (LVAD) explantation remained unclear.
- LVADs are crucial for end-stage heart failure management.
Purpose of the Study:
- To evaluate the prognostic impact of CPX testing on LVAD explantation.
- To develop a predictive score for LVAD explantation risk.
- To identify optimal candidates for LVAD weaning trials.
Main Methods:
- Retrospective analysis of 33 patients with extracorporeal pulsatile flow LVADs.
- Symptom-limited CPX testing performed 3 months post-implantation.
- Cox regression analysis to identify predictors of explantation within 2 years.
Main Results:
- Three CPX parameters significantly predicted explantation: maximum load (E1), minute ventilation/carbon dioxide output slope (E2), and peak oxygen consumption (E3).
- An explantation score (sum of positive E1-3) stratified patients into low (0%), intermediate (29%), and high (86%) 2-year explantation risk groups.
- The score accurately categorized explantation risk in a separate cohort of continuous flow LVAD patients.
Conclusions:
- The explantation score, derived from 3 CPX parameters, is a novel tool for predicting LVAD explantation.
- This score aids in identifying suitable candidates for LVAD weaning and potential explantation.
- CPX testing offers valuable prognostic information beyond survival prediction in LVAD recipients.
Background:
Although cardiopulmonary exercise (CPX) testing is an established tool for predicting survival in patients with heart failure (HF), its prognostic impact on explantation of left ventricular assist device (LVAD) was unknown. METHODS AND RESULTS: We enrolled 33 patients who had undergone implantation of extracorporeal pulsatile flow LVAD and symptom-limited CPX testing at 3 months after operation, and who were followed between 2005 and 2014. Patients who received conversion to continuous flow LVAD were excluded. On Cox regression analysis, E1 (maximum load ≥51W; HR, 27.55), E2 (minute ventilation/carbon dioxide output [V̇E/V̇CO2] slope ≤34; HR, 16.86), and E3 (peak oxygen consumption [PV̇O2] ≥12.8 ml·kg(-1)·min(-1); HR, 18.35) significantly predicted explantation expectancy during 2 years after LVAD implantation (P<0.05 for all). Explantation score, the sum of positive E1-3, significantly stratified 2-year cumulative explantation rate into low (0 points), intermediate (1-2 points), and high (3 points) expectancy groups (0%, 29%, and 86%, respectively, P<0.001). When the scoring system was used for 45 patients with continuous flow LVAD, the 2 patients who had explantation were assigned to the high expectancy group.
Conclusions:
Explantation score, calculated simply from 3 postoperative symptom-limited CPX testing parameters, is a novel tool to predict explantation expectancy of LVAD and to select good candidates for the weaning test.
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