PURPOSE: Lung function as evaluated by pulmonary function testing (PFT) is associated with increased incidence of heart failure (HF) and adverse prognosis in patients with established HF. However, the prognostic importance of PFT at the time of listing in patients evaluated for heart transplantation, in whom PFT is routinely performed, has not been reported.
METHODS: We evaluated the association between PFT parameters at the time of listing and outcomes in 88 consecutive patients (mean age: 54±9 years; 80.7% male; 75% white, 23.9% black; median ejection fraction 10% [interquartile range, 5% to 15%]) listed for non-urgent heart transplantation as UNOS Status 1B (n=53; 60.2%) or UNOS Status 2 (n=35; 39.8%) between 2002 and 2007 in the Emory Center of Heart Failure Therapy and Cardiac Transplantation. The outcome was defined as the composite of death, ventricular assist device (VAD) implantation, or urgent heart transplantation.
RESULTS: Overall %predicted FEV1 was 68.4±16.4; %predicted FVC 73.4±15.7; and FEV1/FVC ratio 0.75±0.12. Median follow-up time was 9 months (interquartile range, 3 to 31 months). Over this period, 40 patients (45.5%) experienced an outcome event (6 died; 1 underwent VAD implantation; and 33 underwent urgent heart transplantation). Baseline PFT parameters were not significantly different between patients who experienced an outcome event and those who did not (%FEV1 66.4±17.3 vs. 70.1±15.6, p=0.28; %FVC 72.2±16.0 vs. 74.3±15.5, p=0.54; FEV1/FVC 0.74±0.14 vs. 0.76±0.09, p=0.45, respectively). No difference was observed in PFT parameters between patients with or without history of smoking and lung disease. In Cox proportional hazards regression analyses, no baseline PFT parameter was predictive of the time to event.
CONCLUSION: Lung function, as evaluated by PFT, was not associated with adverse outcomes in our cohort of listed patients. This finding may be attributed to the selected, homogeneous nature of this subset of advanced HF patients.
CLINICAL IMPLICATIONS: Lung function does not affect outcomes of patients listed for heart transplantation regardless of smoking history.
DISCLOSURE: Vasiliki Georgiopoulou, No Financial Disclosure Information; No Product/Research Disclosure Information