Novel scoring system using postoperative cardiopulmonary exercise testing predicts future explantation of left ventricular assist device

Teruhiko Imamura, Koichiro Kinugawa, Daisuke Nitta, Takeo Fujino, Toshiro Inaba, Hisataka Maki, Masaru Hatano, Osamu Kinoshita, Kan Nawata, Shunei Kyo, Minoru Ono

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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 [VE/VCO2] slope ≤34; HR, 16.86), and E3 (peak oxygen consumption [PV˙O2] ≥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.

Original languageEnglish
Pages (from-to)560-566
Number of pages7
JournalCirculation Journal
Volume79
Issue number3
DOIs
Publication statusPublished - Jan 1 2015

Fingerprint

Heart-Assist Devices
Exercise
Pulsatile Flow
Weaning
Carbon Dioxide
Oxygen Consumption
Ventilation
Heart Failure
Regression Analysis
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Novel scoring system using postoperative cardiopulmonary exercise testing predicts future explantation of left ventricular assist device. / Imamura, Teruhiko; Kinugawa, Koichiro; Nitta, Daisuke; Fujino, Takeo; Inaba, Toshiro; Maki, Hisataka; Hatano, Masaru; Kinoshita, Osamu; Nawata, Kan; Kyo, Shunei; Ono, Minoru.

In: Circulation Journal, Vol. 79, No. 3, 01.01.2015, p. 560-566.

Research output: Contribution to journalArticle

Imamura, T, Kinugawa, K, Nitta, D, Fujino, T, Inaba, T, Maki, H, Hatano, M, Kinoshita, O, Nawata, K, Kyo, S & Ono, M 2015, 'Novel scoring system using postoperative cardiopulmonary exercise testing predicts future explantation of left ventricular assist device', Circulation Journal, vol. 79, no. 3, pp. 560-566. https://doi.org/10.1253/circj.CJ-14-1058
Imamura, Teruhiko ; Kinugawa, Koichiro ; Nitta, Daisuke ; Fujino, Takeo ; Inaba, Toshiro ; Maki, Hisataka ; Hatano, Masaru ; Kinoshita, Osamu ; Nawata, Kan ; Kyo, Shunei ; Ono, Minoru. / Novel scoring system using postoperative cardiopulmonary exercise testing predicts future explantation of left ventricular assist device. In: Circulation Journal. 2015 ; Vol. 79, No. 3. pp. 560-566.
@article{00c250f428fa44eb8d6567ee005c2593,
title = "Novel scoring system using postoperative cardiopulmonary exercise testing predicts future explantation of left ventricular assist device",
abstract = "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 [VE/VCO2] slope ≤34; HR, 16.86), and E3 (peak oxygen consumption [PV˙O2] ≥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.",
author = "Teruhiko Imamura and Koichiro Kinugawa and Daisuke Nitta and Takeo Fujino and Toshiro Inaba and Hisataka Maki and Masaru Hatano and Osamu Kinoshita and Kan Nawata and Shunei Kyo and Minoru Ono",
year = "2015",
month = "1",
day = "1",
doi = "10.1253/circj.CJ-14-1058",
language = "English",
volume = "79",
pages = "560--566",
journal = "Circulation Journal",
issn = "1346-9843",
publisher = "Japanese Circulation Society",
number = "3",

}

TY - JOUR

T1 - Novel scoring system using postoperative cardiopulmonary exercise testing predicts future explantation of left ventricular assist device

AU - Imamura, Teruhiko

AU - Kinugawa, Koichiro

AU - Nitta, Daisuke

AU - Fujino, Takeo

AU - Inaba, Toshiro

AU - Maki, Hisataka

AU - Hatano, Masaru

AU - Kinoshita, Osamu

AU - Nawata, Kan

AU - Kyo, Shunei

AU - Ono, Minoru

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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 [VE/VCO2] slope ≤34; HR, 16.86), and E3 (peak oxygen consumption [PV˙O2] ≥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.

AB - 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 [VE/VCO2] slope ≤34; HR, 16.86), and E3 (peak oxygen consumption [PV˙O2] ≥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.

UR - http://www.scopus.com/inward/record.url?scp=84923444482&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923444482&partnerID=8YFLogxK

U2 - 10.1253/circj.CJ-14-1058

DO - 10.1253/circj.CJ-14-1058

M3 - Article

C2 - 25746540

AN - SCOPUS:84923444482

VL - 79

SP - 560

EP - 566

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 3

ER -