Peak VO2 in Advanced HF — EECC MCQ
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Correct answer: B — Peak VO₂ <12 mL/kg/min (or <14 mL/kg/min without beta-blocker) identifies patients who may benefit from cardiac transplantation, as it predicts 1-year survival <80% with medical therapy alone
Cardiopulmonary exercise testing (CPET) with measurement of peak oxygen consumption (VO₂) is a cornerstone of advanced HF assessment. Peak VO₂ reflects maximal cardiac output and is a powerful prognostic marker. The ESC HF Guidelines and ISHLT transplant guidelines use: peak VO₂ <12 mL/kg/min (on beta-blocker) or <14 mL/kg/min (not on beta-blocker) as a threshold suggesting transplant may be beneficial. VE/VCO₂ slope >35 is an additional poor prognostic marker. This patient's peak VO₂ of 10 mL/kg/min indicates severely limited functional capacity with predicted 1-year mortality >20% on medical therapy. Other advanced HF markers include: persistent NYHA IV, recurrent hospitalisations, progressive renal dysfunction, and rising NT-proBNP despite optimal therapy.
Reference: ESC (2023): HF Guidelines; ISHLT Heart Transplant Guidelines