Uithoven KE; Smith JR; Medina-Inojosa JR; Squires RW; Olson TP;

Journal Of Cardiac Failure [J Card Fail] 2020 Jan 22. Date of Electronic Publication: 2020 Jan 22.

Background: Methods for reducing major adverse cardiac events (MACE) in heart transplant (HTx) patients are critical for long-term quality outcomes.
Methods and Results: Patients with cardiopulmonary exercise testing (CPET) prior to HTx and at least one session of cardiac rehabilitation (CR) after HTx were included. Exercise sessions were evaluated as ≥23 or <23 sessions based on recursive partitioning. 140 HTx patients (women: N=41 (29%), age: 52±12 years, BMI: 27±5 kg/m2) were included. Mean follow-up was 4.1±2.7 years and 44 patients (31%) had a MACE: Stroke (n=1), Percutaneous intervention (n=5), HF (n=6), Myocardial infarction (n=1), rejection (n=16), or death (n=15). CR was a significant predictor of MACE with ≥23 sessions associated with a ∼60% reduction in MACE risk (HR: 0.42, 95% CI: 0.19-0.94, p=0.035). This remained after adjusting for age, sex, and history of diabetes (DM) (HR: 0.41, 95% CI: 0.18-0.94, p=0.035) and BMI and pre-HTx VO2peak (HR: 0.40, 95% CI: 0.18-0.92, p=0.031).
Conclusion: After adjustment for covariates of age, sex, DM, BMI, and pre-HTx VO2peak, CR attendance of ≥23 exercise sessions was predictive of lower MACE risk following HTx. In post-HTx patients, CR was associated with MACE prevention and should be viewed as a critical tool in post-HTx treatment strategy.