Exercise capacity and cardiac allograft ischemic time in recent heart transplant recipients
Katelyn D. Bosteder, MS, CCRP, ACSM-CEP, EIM,
Johanna S. van Zyl, PhD,
Arturo A. Arce-Esquivel, MD, PhD,
Cheryl Cooper, MSN, PhD,
Joost Felius, PhD,
Robert L. Gottlieb, MD, PhD
Affiliations
Katelyn D. Bosteder, MS, CCRP, ACSM-CEP, EIM
Baylor Scott & White Sports Therapy and Research Center at the STAR, Frisco, Texas; Department of Cardiac Rehabilitation, Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas; Department of Kinesiology, School of Health Professions, The University of Texas at Tyler, Tyler, Texas; Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Corresponding author: Katelyn D. Bosteder, MS, CCRP, ACSM-CEP, EIM, Baylor Scott & White Sports Therapy and Research Center at the STAR, 3800 Gaylord Parkway, Frisco, TX 75034.
Johanna S. van Zyl, PhD
Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Texas A&M Health Science Center, Dallas, Texas
Arturo A. Arce-Esquivel, MD, PhD
Department of Kinesiology, School of Health Professions, The University of Texas at Tyler, Tyler, Texas
Cheryl Cooper, MSN, PhD
Department of Kinesiology, School of Health Professions, The University of Texas at Tyler, Tyler, Texas
Joost Felius, PhD
Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Texas A&M Health Science Center, Dallas, Texas
Robert L. Gottlieb, MD, PhD
Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Texas A&M Health Science Center, Dallas, Texas; Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Burnett School of Medicine at TCU, Fort Worth, Texas
Background: Prolonged ischemic times (IT) for transplant hearts transported under cold storage conditions are associated with an increased risk of mortality; however, the impact of IT on functional outcomes, such as exercise capacity (EC), is not fully understood. This prospective, observational cohort study aimed to determine the association between EC, a strong predictor for post-transplant survival, and relatively longer IT. Methods: Thirty heart transplant recipients were grouped dichotomously according to relatively longer (>180 minutes) or shorter (≤180 minutes) IT. A cardiopulmonary exercise test (CPET) was performed post-transplant upon cardiac rehabilitation admission, during which EC [peak volume of oxygen consumption (VO2)] and CPET duration were measured and compared between groups. Results: This cohort was predominantly male (n = 22, 73%) with a median age of 57.5 years [Q1-Q3: 54.0-65.0]. Baseline demographics and characteristics were similar between groups aside from United Network for Organ Sharing listing status, in which patients listed as status 1 or 2 were more likely to have long IT. Twelve (40%) participants received a donor heart with long IT. Surprisingly, higher peak VO2 was observed in those with long (15.0±2.8) than short (13.1±3.7) IT (p = 0.009). However, CPET duration was significantly shorter in recipients with a long IT (6.3 vs 7.7 minutes, p = 0.048) despite similar time since transplant, ratings of perceived exertion, protocol performed, and EC. Conclusions: In this modest-sized cohort, EC was higher in heart transplant recipients with donor IT >180 minutes compared with those with IT ≤180 minutes. However, CPET duration was significantly shorter in those with relatively longer IT.
