Cholinesterase levels predict exercise capacity in cardiac recipients early after transplantation

Clinical features and determinants of VO2peak in de novo heart transplant recipients

AIM

To study exercise capacity and determinants of early peak oxygen consumption (VO_2peak) in a cohort of de novo heart transplant (HTx) recipients.

METHODS

To determine possible central (chronotropic responses, cardiopulmonary and hemodynamic function) and peripheral factors (muscular exercise capacity and body composition) predictive of VO_2peak, a number of different measurements and tests were performed, as follows: Cardiopulmonary exercise testing (CPET) was performed mean 11 wk after surgery in 81 HTx recipients > 18 years and was measured with breath by breath gas exchange on a treadmill or bicycle ergometer. Metabolic/respiratory measures include VO_2peak and VE/VCO₂ slope. Additional measures included muscle strength testing, bioelectrical impedance analysis, echocardiography, blood sampling and health-related quality of life. Based on the VO_2peak (mL/kg per minute) median value, the study population was divided into two groups defined as a low-capacity group and a high-capacity group. Potential predictors were analyzed using multiple regression analysis with VO_2peak (L/min) as the dependent variable.

RESULTS

The mean ± standard deviation (SD) age of the total study population was 49 ± 13 years, and 73% were men. This de novo HTx cohort demonstrated a median VO_2peak level of 19.4 mL/kg per min at 11 ± 1.8 wk post-HTx. As compared with the high-capacity group, the low-capacity group exercised for a shorter time, had lower maximal ventilation, O₂ pulse, peak heart rate and heart rate reserve, while the VE/VCO₂ slope was higher. The low-capacity group had less muscle strength and muscular exercise capacity in comparison with the high-capacity group. In order of importance, O₂ pulse, heart rate reserve, muscular exercise capacity, body mass index, gender and age accounted for 84% of the variance in VO_2peak (L/min). There were no minor or major serious adverse events during the CPET.

CONCLUSION

Although there is great individual variance among de novo HTx recipients, early VO_2peak measures appear to be influenced by both central and peripheral factors.