The dynamic of physical capacity and quality of life in recipients after heart transplantation
Maria Simonenko1,2, Aelita Berezina2, Petr Fedotov3, Olga Tarasova3, Tatiana Lelyavina3, Mikhail Karpenko4, Maria Sitnikova3.
1Heart transplantation Outpatient Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 2Cardiopulmonary exercise test research department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 3Heart Failure Research Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 4Scientific and Clinical Council, First Deputy General Director, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
Objective: to estimate the dynamic of physical capacity (PC) and quality of life (QoL) in recipients after heart transplantation (HTx).
Methods: We analyzed the data collected from January 2010 to December 2019 where 131 heart transplant patients (mean age - 47±13 year-old; 100 – male) were included. Recipients performed cardiopulmonary exercise test (CPET) before, 3 months, 1 and 3 years after HTx. Dynamics of VO2peak and ventilatory efficiency (VE/VCO2slope) were measured. Physical activity (PA) was defined by IPAQ questionnaire. We estimated the dynamic of physical (PCS) and mental component summary (MCS) by SF-36 questionnaire.
Results: In 3 months PC significantly increased (VO2peak – 15.6±0.5 ml/min/kg, p<0.001; VO2pred – 53.8±1.7, p<0.001) and VE/VCO2slope decreased (38.2±1.1, p=0.004). Following 1 year after HTx level of PC continue improving (VO2peak – 18.5±0.5 ml/min/kg, p<0.001; VO2pred – 66.3±2.1, p<0.001; VE/VCO2slope – 36.3±0.9, p=0.148) and results remain stable in 3 years (VO2peak – 18.7±0,5, p=0.130; VO2pred – 67.9±1.9, p<0.001; VE/VCO2slope – 36.8±0.9, p=0.017). According to IPAQ results, less than half of patients were physically active (3 months after HTx – 39% (n=45 from 115); 1 year – 46% (n=50 from 109); 3 years – 48% (n=34 from 71), others preferred a sedentary lifestyle. Three months after HTx 58% reached normal values of PC, in 1 year – 68% and in 3 years – 66%. Physically active recipients showed better results of VO2peak than those who had sedentary lifestyle (3 months – 17.0±0.8 vs. 15.2±0.5, p=0.032; 1 year – 19.4±0.8 vs. 16.9±0.4, p<0.001). PCS also increased (3 months – 41.4±1.1, p<0.001; 1 year – 46.6±1.0, p<0.001) and in 3 years remained stable (46.6±1.0, p=0.882). At the same time in 3 months after HTx MCS improved (48.1±0.9, p=0.001) but then started to slowly decrease (1 year – 46.7±0.8, p=0.064; 3 years – 45.4±0.8, p=0.117). We found correlations between age and CPET results (VO2peak - 3 months (r=-0.460, p<0.001), 3 years (r=-0.320, p=0.011); VE/VCO2slope - 3 months (r=0.419, p<0.001), 1 year (r=0.381, p=0.001), 3 years ((r=0.355, p=0.005)) and PCS (3 months – r=-0.391, p<0.001; 1 year – r=-0.341, p<0.001; 1 year – r=-0.363, p=0.002). There were correlations between VO2peak and donors’ age (1 year – r=-0.318, p=0.006; 3 years - r=-0.337, p=0.008) and PA (1 year – r=0.313, p=0.006; 3 years - r=-0.337, p=0.008). The levels of PCS correlated with VO2peak (3 months - r=0.366, p=0.005; 1 year – r=0.397, p<0.001; 3 years – r=0.361, p=0.006) and with VE/VCO2slope (1 year – r=-0.441, p<0.001; 3 years – r=-0.378, p=0.004).
Conclusion: All heart transplant recipients improved their physical capacity and quality of life and remained levels of them stable long-term after HTx. Physically active patients showed better results while the older donor and/or recipient’s age are negative factors in reaching normal values of VO2peak.
