Circulation, Vol 81, 78-85, Copyright © 1990 by American Heart Association
LW Stevenson, K Sietsema, JH Tillisch, V Lem, J Walden, JA Kobashigawa and J Moriguchi
Cardiac transplantation is predicted to improve survival for patients with
severe symptoms of heart failure and ejection fraction of 20% or less, but
the exercise capacity after cardiac transplantation is less than normal.
Patients responding to vasodilators and diuretics have progressive
improvement in exercise capacity despite low ejection fraction. We
hypothesized that among patients currently considered appropriate for
transplantation who could nonetheless subsequently be stabilized on medical
therapy tailored to hemodynamic goals, survivors after 6 months of
sustained medical therapy would demonstrate exercise capacity comparable to
that of survivors of transplantation. Of 146 patients referred, 118 (81%)
were discharged on tailored therapy without transplantation, and 88 (60%)
were stable for at least 1 month. Stability after discharge was more likely
in patients with lower right atrial pressures and better renal function on
therapy. Of the 88 stable patients, 45 patients were listed for transplant,
and 43 were ineligible or unwilling. From these patients, 42 survivors for
more than 6 months follow-up after cardiac transplantation or tailoring of
medical therapy underwent exercise testing. Baseline functional and
hemodynamic status and left ventricular ejection fraction (15 +/- 4%) were
not different between the transplant and sustained medical survivor groups
at the time of initial evaluation. After 14 +/- 6 months, left ventricular
ejection fraction had increased to 62 +/- 7% after transplantation (p less
than 0.01) and only 22 +/- 9% after sustained medical therapy (p less than
0.05). However, there were no significant differences in the maximum
workload, oxygen uptake, anaerobic threshold, or maximum oxygen pulse
between survivors of cardiac transplantation and survivors on sustained
medical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Exercise capacity for survivors of cardiac transplantation or sustained medical therapy for stable heart failure
Division of Cardiology, UCLA School of Medicine 90024.
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