CPET results (looking at you slewyn and crustyg)

So I got my complete CPET results (done for transplant consideration and prognostic marker). I saw the advanced HF/Transplant doc today, he says it's time to start talking about transplant (which I thought was funny because clearly we are already talking about it, it's why we ordered the test.  Some of my results came back better than expected some worse so I am not sure where I stand really.  He drew blood today for antibody testing and pro-bnp as well.  Anyways the summary is a bit short and he says he is going to try and get the raw data from the lab to look closer at it.  Here's the results:

Peak vo2: 20.2 ml/kg/min (57% predicted)

Abnormal o2 pulse: 5.7 ml/beat (48% predicted)

VE/VCO2 slope: 37.3

AT: 0.914 L/min (43% of predicted maxVO2)

Breathing Reserve: 34%
Peak RQ: 1.31

So I guess where I am confused is that my peak VO2 is clearly above the transplant listing cutoff of 14, however my VE/VCO2 slope is above the cutoff my transplant doc told me was 34 (so meeting transplant list criteria).  How do they make a decision when I meet one criteria and not the other?  Also, I read some papers that said if the regular cpet testing protocol is used in HFrEF patients as opposed to the slow gradual increase protocol it can artificially inflate peak VO2, and wouldnt they use my VO2max since I did hit AT, not my peakVO2? Because if the go of that I am under 50% predicted VO2max which would indicate listing?

Anyways he didn't give me clear answers as to whether I met the criteria or not, so I am not sure if the plan is to move forward with testing for listing or to wait until I am sicker.  He did say when I come back in 6 weeks he is going to order another right heart cath.  No matter if they list me now or later I suppose it doesn't really matter since I am blood type o positive and the wait is so long that generally you won't get one until your hospitalized and on inotropes and move into urgent status.


2 Comments

Sloping shoulders coming...

by crustyg - 2021-03-22 18:58:06

The horrible truth is that donor organs are so scarce that the transplant teams want to get the best possible results from the hearts of those who have made the Ultimate Contribution.  And that means trying to balance the best possible clinical benefit (helping those for whom a new heart will be life-transforming) but not waste them in recipients who are too far gone to be able to get much mileage out of the donated organ.

As I said in my private message, this level of testing - and the current criteria used to decide who does and who does not get a heart is outside my experience.  I wish I could help more, but it would only be guessing.  Sorry.

Thanks crustyg

by asully - 2021-03-24 12:35:52

Thanks for responding, at this point I know stuff just really begins to be on a case by case basis and is hard to predict even for the transplant doctors themselves.  I just hate dealing in non-answers, I like numbers and data, so my mind wants to answer a question that can't be answered lmao.  Funny thing, I got a call from the EP today and he "thinks" he can improve my heart function with His bundle pacing...which is funny because on Monday the hf doc and I were talking about transplant.  And so the saga continues....

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