Usefulness of Cardiopulmonary Exercise Testing for Cardiovascular Risk Estimation and Frailty Assessment in Liver Transplant Candidates
Condition: Cardiovascular Diseases+Liver Transplantation
MeSH terms: Cardiovascular Diseases; Frailty
Study type: Interventional

Summary: 
      Patients undergoing liver transplantation (LT) have a high risk for cardiovascular disease
      (CVD). Frailty is a frequent condition among LT candidates. Together, CVD and frailty are
      major causes of morbidity and mortality before and after LT. Conventional methods to diagnose
      and predict CVD in LT candidates lack sensitivity and clinically relevant application.
      However, cardiopulmonary exercise testing (CPET) can directly estimate coronary artery
      disease, cirrhotic cardiomyopathy, and indirectly assess frailty. Such versatility of CPET
      has caused it to become the standard of care in many LT centers outside of the United States.

      In preliminary work that will be used to fund a more definitive study (RO1), the
      investigators plan to investigate CVD and frailty in LT candidates, both from existing
      standard of care (SOC) methods and CPET. The investigators expect results to improve the
      current capacity to assess and prognosticate CVD and frailty in LT, ultimately changing
      practice.
    

Detailed description: 
      Patients undergoing liver transplantation (LT) have a high risk for cardiovascular disease
      (CVD). Frailty is a frequent condition among LT candidates. Together, CVD and frailty are
      major causes of morbidity and mortality before and after LT. Conventional methods to diagnose
      and predict CVD in LT candidates lack sensitivity and clinically relevant application.
      However, cardiopulmonary exercise testing (CPET) can directly estimate coronary artery
      disease, cirrhotic cardiomyopathy, and indirectly assess frailty. Such versatility of CPET
      has caused it to become the standard of care in many LT centers outside of the United States.
      In preliminary work that will be used to fund a more definitive study (RO1), the
      investigators plan to investigate CVD and frailty in LT candidates, both from existing
      standard of care (SOC) methods and CPET. The investigators expect results to improve the
      assessment of CVD and frailty in LT, ultimately changing practice. The investigators'
      proposal will pursue the following Specific Aims (SA):

      Aim 1: Prospectively determine agreement between cardiopulmonary exercise testing and cardiac
      stress testing (SOC), for the identification of subclinical coronary artery disease in liver
      transplant candidates.

      Aim 2: Prospectively determine agreement between cardiopulmonary exercise testing and
      dobutamine stress echocardiogram (SOC), for the identification of cirrhotic cardiomyopathy in
      liver transplant candidates.

      Aim 3: Prospectively determine agreement between peak oxygen consumption from cardiopulmonary
      exercise testing and the liver frailty index or the six-minute walk test (SOC), for the
      identification of frailty in liver transplant candidates.
    

Intervention name(s): Cardiopulmonary exercise testing
Intervention type(s): Device
Intervention description(s): Subjects will perform cardiopulmonary exercise testing which consists of biking on a cycle ergometer (recumbant stationary bicycle) while breathing through a mouthpiece or mask to measure the oxygen and carbon dioxide in the subject's breath.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic