Hypotensive Response on Cardiopulmonary Stress Test is Associated with Increased Hospitalization Length of Stay Following Orthotopic Heart Transplantation.

Cardiopulmonary stress test (CPX) is widely used to evaluate patients with end-stage heart failure who may benefit from advanced therapies, such as orthotopic heart transplantation (OHT). A hypotensive systolic blood pressure response on CPX may identify a subpopulation with the highest risk physiology. We sought to evaluate outcomes among OHT recipients with a pre-implantation hypotensive response. This retrospective single-center study evaluated consecutive patients undergoing OHT between 1/2011 and 6/2020 at our institution. Patients with CPX performed within 12 months before transplantation were included. Patients bridged with left ventricular assist devices (LVAD) were excluded. Hypotensive response was defined as a peak exercise systolic blood pressure lower than the resting systolic blood pressure. Hospital length of stay was right-skewed and thus log-transformed for analysis. Multivariable regression models were used to evaluate the relation between hypotensive exercise blood pressure response and hospital outcomes. Data for 211 patients were reviewed. 76 patients were identified to meet our inclusion criteria. The median age was 59.6 years. 26 patients had a hypotensive response on CPX (34%). Those with a normal blood pressure response on CPX had a 21% shorter length of stay (16 days vs 21 days, p=0.05). This remained unchanged when adjusting for age. There were no significant differences in postoperative complications or 1-year survival. Hypotensive blood pressure response on the CPX performed pre-OHT is independently associated with increased hospital length of stay. Additional studies are needed to further characterize this high-risk patient population and to identify strategies to optimize outcomes. [ABSTRACT FROM AUTHOR]