Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival

Thomas C. Hanff, Yuhui Zhang, Robert S. Zhang, Michael V. Genuardi, Maria Molina, Rhondalyn C. McLean, Jeremy A. Mazurek, Monique S. Tanna, Joyce W. Wald, Pavan Atluri, Michael A. Acker, Lee R. Goldberg, Payman Zamani, Edo Y. Birati

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Decreased peak oxygen consumption during exercise (peak Vo2) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo2 as a marker of post-transplant survival is not well established. Methods and Results: We performed a retrospective analysis of adult heart transplant recipients at the Hospital of the University of Pennsylvania who underwent cardiopulmonary exercise testing within a year of transplant between the years 2000 to 2011. Using time-to-event models, we analyzed the hazard of mortality over nearly two decades of follow-up as a function of post-transplant percent predicted peak Vo2 (%Vo2). A total of 235 patients met inclusion criteria. The median post-transplant %Vo2 was 49% (IQR 42 to 60). Each standard deviation (±14%) increase in %Vo2 was associated with a 32% decrease in mortality in adjusted models (HR 0.68, 95% CI 0.53 to 0.87, p = 0.002). A %Vo2 below 29%, 64% and 88% predicted less than 80% survival at 5, 10, and 15 years, respectively. Conclusions: Post-transplant peak Vo2 is a highly significant prognostic marker for long-term post-transplant survival. It remains to be seen whether decreased peak Vo2 post-transplant is modifiable as a target to improve post-transplant longevity.

Original languageEnglish
Article number366
JournalJournal of Clinical Medicine
Issue number1
StatePublished - 3 Jan 2023

Bibliographical note

Publisher Copyright:
© 2023 by the authors.


TCH was supported by the National Institute of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) T32 Training Grant HL-007891.

FundersFunder number
National Institutes of Health
National Heart, Lung, and Blood InstituteHL-007891


    • exercise
    • prognosis
    • survival
    • transplant


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