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CLINICAL RESEARCH: HEART FAILURE

Effects of Gender on Peak Oxygen Consumption and the Timing of Cardiac Transplantation

Sammy Elmariah, MD^_*, Lee R. Goldberg, MD, MPH, FACC^_*, Michael T. Allen, EMT-P^_* and Andrew Kao, MD, FACC^,_*

^_* Department of Medicine, Cardiovascular Division, Heart Failure and Cardiac Transplant Program, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Cardiovascular Consultants, Mid-America Heart Institute, Kansas City, Missouri

Manuscript received May 18, 2005; revised manuscript received November 21, 2005, accepted November 28, 2005.

^_* Reprint requests and correspondence: Dr. Andrew Kao, Cardiovascular Consultants, PC, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111. (Email: akao{at}cc-pc.com).

OBJECTIVES: This study examines the gender effects on peak exercise oxygen consumption (VO₂) and survival in heart failure (HF) patients and their implications for cardiac transplantation.

BACKGROUND: The predictive value of peak VO₂ in women HF patients is poorly established but is one of the indicators used to optimally time cardiac transplantation in women.

METHODS: A total of 594 ambulatory HF patients (mean age 52 ± 12 years, 28% women, mean left ventricular ejection fraction 26 ± 12%, 73% on beta-blocker) underwent symptom-limited exercise tests with breath-by-breath expired gas analyses using ramped treadmill protocols. Kaplan-Meier survival curves were generated for each gender and compared using log-rank tests.

RESULTS: Women had a significantly lower peak VO₂ than men (14.0 ± 4.9 ml/kg/min vs. 16.6 ± 7.1 ml/kg/min; p < 0.0001), despite being younger (48.9 ± 11.5 years vs. 53.2 ± 12.4 years; p < 0.0001) and having a higher left ventricular ejection fraction (29 ± 13% vs. 25 ± 11%; p < 0.0003). However, the one-year transplant-free survival was significantly lower for men than for women (81% vs. 94%, p < 0.0001), a finding seen across each Weber class. Cox regression analyses confirmed the protective effects of female gender on transplant-free survival when controlling for peak VO₂, age, race, beta-blocker use, and type of cardiomyopathy. The peak VO₂ associated with 85% one-year transplant-free survival was significantly higher in men than in women (11.5 vs. 10.0 ml/kg/min).

CONCLUSIONS: Women had a significantly lower peak VO₂ than men, but had better survival at all levels of exercise capacity. The current practice of uniform application of peak VO₂ as an aid to determine cardiac transplantation timing should be re-examined.

Abbreviations and Acronyms   HF = heart failure   LVEF = left ventricular ejection fraction   OHT = orthotopic heart transplant   RER = respiratory exchange ratio   VO2 = oxygen consumption

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