Severe heart failure prognosis evaluation for transplant selection in the era of beta-blockers: role of peak oxygen consumption.

Peak oxygen consumption (VO2) is used to define the severity of heart failure (HF) [1] and [2] and as a criteria for heart transplant (HT) listing [3], [4] and [5]. Progressive improvement of HF patients' survival [6], even due to beta-blockers therapy [7] and [8], requires a continuous re-evaluation of severity judgment by peakVO2. The decision to list HF patients for HT is complex and maximal CPX is a useful test for this purpose, being peakVO2 values used in the decision making for HT according to the last published HT guidelines by the International Society for Heart and Lung Transplantation (ISHLT) [4]. More recently, American and European guidelines for the management of HF indicated lower limits, making crucial the constant re-evaluation of listing criteria [1] and [3]. Moreover, the post-HT survival rate has showed some but relatively minor improvement in the past years, being, at present, 90% at 1 year, 75% at 5 years and 50% at 10 years in the general population of transplanted patients [6]. In contrast, survival for HF patients, independently of HT, has significantly improved in the current era, even due to beta-blocker therapy [3] and [6].