Comparison Across Races of Peak Oxygen Consumption and Heart Failure Survival Score for Selection for Cardiac Transplantation

The aim of the present study was to determine whether peak oxygen consumption (VO2) and the Heart Failure Survival Score (HFSS) predict prognosis in European-American, African-American, and Hispanic-American patients with chronic heart failure referred for heart transplantation. The peak VO2 and the HFSS have previously been shown to effectively risk stratify patients with chronic heart failure and are criteria for the listing for heart transplantation. However, the effect of race on the predictive value of these variables has not been studied. A total of 715 patients with congestive heart failure (433 European American, 126 African American, 123 Hispanic American, and 33 other), who had been referred for heart transplantation, underwent cardiopulmonary exercise testing with measurement of the peak VO2 and calculation of the HFSS. A total of 354 patients had died or undergone urgent heart transplantation or implantation of a left ventricular assist device during the 962 ± 912 days of follow-up. On univariate and multivariate Cox hazard analysis, both peak VO2 and the HFSS were powerful prognostic markers in the overall cohort and in the separate races. In the receiver operating characteristic curve analysis, the areas under the curve at 1 and 2 years of follow-up were greater for the HFSS than for peak VO2. In conclusion, HFSS and peak VO2 can be used for transplant selection; however, in the era of modern therapy and across races and genders, the HFSS might perform better than the peak VO2.