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Safety and Utility of Cardiopulmonary Exercise Testing in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Background Arrhythmogenic right ventricular cardiomyopathy/dysplasia ( ARVC /D) is characterized by high arrhythmic burden and progressive heart failure, which can prompt referral for heart transplantation. Cardiopulmonary exercise testing ( CPET ) has an established role in risk stratification for advanced heart failure therapies, but has not been described in ARVC /D. This study sought to determine the safety and prognostic utility of CPET in patients with ARVC /D. Methods and Results Using the Johns Hopkins ARVC /D Registry, we examined patients with ARVC /D undergoing CPET . Baseline characteristics and transplant‐free survival were compared on the basis of peak oxygen consumption (pVO2) (≤14 or >14 mL/kg per minute) and ventilatory efficiency (Ve/ VCO 2 slope ≤34 or >34). Thirty‐eight patients underwent 50 CPET s. There were no sustained arrhythmic events. Twenty‐nine patients achieved a maximal test. Patients with pVO2 ≤14 mL/kg per minute were more often men ( P =0.042) compared with patients with pVO2 >14 mL/kg per minute. Patients with Ve/ VCO 2 slope >34 tended to have more moderate/severe right ventricular dilation (7/9 [78%] versus 10/26 [38%]; P =0.060) and clinical heart failure (8/9 [89%] versus 13/26 [50%]; P =0.056) compared with patients with Ve/ VCO 2 slope ≤34. Patients who underwent heart transplantation were more likely to have clinical heart failure (10/10 [100%] versus 13/28 [46%]; P =0.003). Patients with Ve/ VCO 2 slope >34 had worse transplant‐free survival compared with patients with Ve/ VCO 2 slope ≤34 (n=35; hazard ratio, 6.57 [95% CI , 1.28–33.72]; log‐rank P =0.010), whereas transplant‐free survival was similar on the basis of pVO2 groups (n=29; hazard ratio, 3.38 [95% CI , 0.75–15.19]; log‐rank P =0.092). Conclusions CPET is safe to perform in patients with ARVC /D. Ve/ VCO 2 slope may be used for risk stratification and guide referral for heart transplantation in ARVC /D.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
Referral
Cardiomyopathy
030204 cardiovascular system & hematology
Risk Assessment
Right ventricular cardiomyopathy
Young Adult
03 medical and health sciences
Oxygen Consumption
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Internal medicine
Genetics
medicine
Humans
Registries
030212 general & internal medicine
Arrhythmogenic Right Ventricular Dysplasia
Retrospective Studies
Original Research
Heart Failure
arrhythmogenic right ventricular cardiomyopathy
Exercise Tolerance
business.industry
Editorials
right ventricular failure
Cardiopulmonary exercise testing
Middle Aged
medicine.disease
Progression-Free Survival
Transplantation
Editorial
Dysplasia
Heart failure
Exercise Test
Cardiology
Heart Transplantation
Female
cardiac transplant
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 20479980
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association
- Accession number :
- edsair.doi.dedup.....b24d21af231d1ccbbc14c1ce7c9ea548