Hypotensive Response On Cardiopulmonary Stress Test Is Not Associated With Worse Post-heart Transplant Clinical Outcomes And Mortality.

Cardiopulmonary stress test (CPT) is widely used in patients with heart failure to objectively determine functional capacity and to aid in establishing advanced therapy candidacy. We have recently shown that hypotensive blood pressure (BP) response on CPT performed within 1 year of LVAD implantation is associated with worse perioperative and 90-days mortality. Here we extended the study and examined the association in patients undergoing orthotopic heart transplant (OHT). We performed a retrospective, single-center analysis of consecutive patients that underwent OHT between January 2011 and June 2020 at the University of Minnesota. Patients that had a valid CPT performed within 1 year prior to organ acceptance were included. Those with a durable mechanical circulatory support device, multi-organ recipients and those with re-transplantation were excluded. The final cohort was divided into two groups: 1) hypotensive BP response; 2) normal BP response to exercise on CPT. Hypotensive BP response was defined as peak exercise systolic BP lower than the value obtained at rest. Population characteristics were collected through EMR review. Kaplan-Meier survival curves were generated to compare survival up to 4 years between the two groups. Of the identified 256 first-time OHT recipients, 56 met inclusion criteria and were included in the final cohort. The most common reasons to exclude recipients were the presence of LVAD at the time of transplant and the lack of pre-OHT CPT. The mean age was 57.0±11 years and 37 were male (66%). 21 patients (38%) showed hypotensive BP response on CPT. Recipient age, gender distribution, routine laboratory values, temporary mechanical circulatory support device use, and all other CPT parameters were similar between the groups, including peak exercise heart rate, VO 2max , RER, and VE/VCO 2 slope. While those with a hypotensive response had longer median index hospitalization [22 (12, 30) vs. 16 (12, 26) days], the difference was not statistically significant (p=0.89). In addition, we found no difference in ICU length of stay, duration of vasoactive medication use, or incidence of post-transplant end-organ dysfunction. Post-transplant survival rates for up to 4 years were similar between the groups (p=0.74). Hypotensive blood pressure response on CPT performed pre-OHT is not associated with worse post-transplant outcomes and survival up to 4 years. These findings are different from that in LVAD recipients and further studies are needed to clarify the underlying pathophysiological mechanisms. [ABSTRACT FROM AUTHOR]