Peak Oxygen Uptake for Risk Stratification in Fully Magnetically Levitated Left Ventricular Assist Device Recipients

Peak oxygen uptake (pVO ₂ ) is a validated prognostic marker in advanced heart failure (HF), but its value in contemporary recipients of left ventricular assist devices (LVAD) is uncertain. We assessed whether pVO ₂ predicts long-term clinical outcomes in a cohort of exclusively HeartMate 3 recipients. We retrospectively studied 250 recipients at two European centers (2015–2025) who completed cardiopulmonary exercise testing 90–400 days postimplant. The median age was 56.7 years, 29% were female, and the median pVO ₂ was 13.0 (10.7–16.8) ml/kg/min. Low pVO ₂ (≤12 ml/kg/min on β-blocker or ≤14 off) was observed in 52%. During a median follow-up of 770 days, low pVO ₂ was associated with inferior 5-year overall survival (57% vs . 84%; hazard ratio [HR], 3.23; 95% confidence interval [CI], 1.49–7.14) and survival free from heart failure recurrence (44% vs . 78%; HR, 3.13; 95% CI, 1.69–5.88). Each 1 ml/kg/min increase in pVO ₂ reduced the hazard of death or HF recurrence by 16% ( p < 0.001). Low pVO ₂ was also associated with a greater hospitalization burden and more ventricular arrhythmias, but no association with hemocompatibility-related adverse events. In contemporary LVAD recipients, pVO ₂ predicts mortality and clinically relevant nonmortality outcomes, supporting cardiopulmonary exercise testing for long-term risk stratification and management in stable LVAD patients.