Aimee M Layton1, Hilary F Armstrong2, Matthew R Baldwin3, Anna J Podolanczuk3, Nicole M Pieszchata4, Jonathan P Singer5, Selim M Arcasoy3, Kimberly S Meza6, Frank D'Ovidio7, David J Lederer8. 1. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA. Electronic address: aml2135@cumc.columbia.edu. 2. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA. 3. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA. 4. Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA. 5. Department of Medicine, University of California San Francisco, San Francisco, CA, USA. 6. Barnard College, Columbia University, New York, NY, USA. 7. Department of Surgery, Columbia University Medical Center, New York, NY, USA. 8. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
Abstract
BACKGROUND: Frail lung transplant candidates are more likely to be delisted or die without receiving a transplant. Further knowledge of what frailty represents in this population will assist in developing interventions to prevent frailty from developing. We set out to determine whether frail lung transplant candidates have reduced exercise capacity independent of disease severity and diagnosis. METHODS: Sixty-eight adult lung transplant candidates underwent cardiopulmonary exercise testing (CPET) and a frailty assessment (Fried's Frailty Phenotype (FFP)). Primary outcomes were peak workload and peak aerobic capacity (V˙O2). We used linear regression to adjust for age, gender, diagnosis, and lung allocation score (LAS). RESULTS: The mean ± SD age was 57 ± 11 years, 51% were women, 57% had interstitial lung disease, 32% had chronic obstructive pulmonary disease, 11% had cystic fibrosis, and the mean LAS was 40.2 (range 19.2-94.5). In adjusted models, peak workload decreased by 10 W (95% CI 4.7 to 14.6) and peak V˙O2 decreased by 1.8 mL/kg/min (95% CI 0.6 to 2.9) per 1 unit increment in FFP score. After adjustment, exercise tolerance was 38 W lower (95% CI 18.4 to 58.1) and peak V˙O2 was 8.5 mL/kg/min lower (95% CI 3.3 to 13.7) among frail participants compared to non-frail participants. Frailty accounted for 16% of the variance (R2) of watts and 19% of the variance of V˙O2 in adjusted models. CONCLUSION: Frailty contributes to reduced exercise capacity among lung transplant candidates independent of disease severity.
BACKGROUND: Frail lung transplant candidates are more likely to be delisted or die without receiving a transplant. Further knowledge of what frailty represents in this population will assist in developing interventions to prevent frailty from developing. We set out to determine whether frail lung transplant candidates have reduced exercise capacity independent of disease severity and diagnosis. METHODS: Sixty-eight adult lung transplant candidates underwent cardiopulmonary exercise testing (CPET) and a frailty assessment (Fried's Frailty Phenotype (FFP)). Primary outcomes were peak workload and peak aerobic capacity (V˙O2). We used linear regression to adjust for age, gender, diagnosis, and lung allocation score (LAS). RESULTS: The mean ± SD age was 57 ± 11 years, 51% were women, 57% had interstitial lung disease, 32% had chronic obstructive pulmonary disease, 11% had cystic fibrosis, and the mean LAS was 40.2 (range 19.2-94.5). In adjusted models, peak workload decreased by 10 W (95% CI 4.7 to 14.6) and peak V˙O2 decreased by 1.8 mL/kg/min (95% CI 0.6 to 2.9) per 1 unit increment in FFP score. After adjustment, exercise tolerance was 38 W lower (95% CI 18.4 to 58.1) and peak V˙O2 was 8.5 mL/kg/min lower (95% CI 3.3 to 13.7) among frail participants compared to non-frail participants. Frailty accounted for 16% of the variance (R2) of watts and 19% of the variance of V˙O2 in adjusted models. CONCLUSION: Frailty contributes to reduced exercise capacity among lung transplant candidates independent of disease severity.
Authors: Jonathan P Singer; Joshua M Diamond; Cynthia J Gries; Jamiela McDonnough; Paul D Blanc; Rupal Shah; Monica Y Dean; Beverly Hersh; Paul J Wolters; Sofya Tokman; Selim M Arcasoy; Kristy Ramphal; John R Greenland; Nancy Smith; Pricilla Heffernan; Lori Shah; Pavan Shrestha; Jeffrey A Golden; Nancy P Blumenthal; Debbie Huang; Joshua Sonett; Steven Hays; Michelle Oyster; Patricia P Katz; Hilary Robbins; Melanie Brown; Lorriana E Leard; Jasleen Kukreja; Matthew Bacchetta; Errol Bush; Frank D'Ovidio; Melanie Rushefski; Kashif Raza; Jason D Christie; David J Lederer Journal: Am J Respir Crit Care Med Date: 2015-12-01 Impact factor: 21.405
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Hilary F Armstrong; P Christian Schulze; Matthew Bacchetta; Wilawan Thirapatarapong; Matthew N Bartels Journal: Respirology Date: 2014-05-06 Impact factor: 6.424
Authors: Mariève Doucet; Aaron P Russell; Bertrand Léger; Richard Debigaré; Denis R Joanisse; Marc-André Caron; Pierre LeBlanc; François Maltais Journal: Am J Respir Crit Care Med Date: 2007-05-03 Impact factor: 21.405
Authors: Roland Wensel; Christian F Opitz; Stefan D Anker; Jörg Winkler; Gert Höffken; Franz X Kleber; Rakesh Sharma; Manfred Hummel; Roland Hetzer; Ralf Ewert Journal: Circulation Date: 2002-07-16 Impact factor: 29.690
Authors: Aimee M Layton; Andrew M Irwin; Erin C Mihalik; Emily Fleisch; Claire L Keating; Emily A DiMango; Lori Shah; Selim M Arcasoy Journal: Int J Telemed Appl Date: 2021-02-26
Authors: Joanna M Schaenman; Joshua M Diamond; John R Greenland; Cynthia Gries; Cassie C Kennedy; Amit D Parulekar; Dmitry Rozenberg; Jonathan P Singer; Lianne G Singer; Laurie D Snyder; Sangeeta Bhorade Journal: Am J Transplant Date: 2020-12-24 Impact factor: 9.369