Correspondence

Superior Athletic Performance Two Decades after Cardiac Transplantation

N Engl J Med 2007; 356:2007-2008May 10, 2007

Article

To the Editor:

Cardiac-transplant recipients have a severely reduced exercise capacity (defined as the maximum volume of oxygen consumed [VO₂]), in part because of chronotropic incompetence associated with cardiac denervation.1 The upper limits of athletic performance and exercise capacity in the long term after cardiac transplantation are not clear. We report superior exercise capacity and athletic performance in a man two decades after he underwent cardiac transplantation.

The patient underwent cardiac transplantation in August 1986, at 26 years of age. Other than a history of post-transplantation hypertension that was easily controlled with the use of calcium-channel blockers, he has had an uneventful course since the surgery, with no biopsy-proven or clinical evidence of rejection. He has been physically active, performing aerobic exercise 2 to 3 days per week. In October 2004, at 45 years of age, he participated in a 12-week exercise study at our center. His peak VO₂ after training (59 ml per kilogram of body weight per minute) was similar to the peak VO₂ achieved by age-matched, endurance-trained male athletes.2 He had a rapid increase in heart rate from rest to peak exercise (change in heart rate, 81 beats per minute), and the rate returned toward baseline during recovery. His peak heart rate during exercise (177 beats per minute) was similar to the rate among age-matched healthy persons.3 Eighteen years after the transplantation, he completed a half-ironman triathlon in 6 hours and 28.7 minutes (finishing as the 454th of 558 competitors). A year later, he completed the same triathlon in 6 hours and 15.9 minutes (416th of 611 competitors). He also completed an Olympic distance triathlon in 3 hours and 2.1 minutes (75th of 126 competitors).

Cardiac-transplant recipients typically attain their highest peak VO₂ within the first year after surgery.4 In contrast, our patient's experience illustrates that long-term aerobic training may result in a dramatic improvement in exercise capacity. One contributing factor is that his heart-rate response to stress was similar to that in cardiac-transplant recipients who have functional evidence of cardiac reinnervation.5 This patient's history shows that superior athletic performance can be achieved two decades after cardiac transplantation.

Mark Haykowsky, Ph.D.
Wayne Tymchak, M.D.
University of Alberta, Edmonton, AB T6G 2B7, Canada
mark.haykowsky@ualberta.ca

5 References

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Citing Articles (1)

Citing Articles

1. 1

   Mark J. Haykowsky, Kenneth Riess, Ilene Burton, Lee Jones, Wayne Tymchak. (2009) Heart Transplant Recipient Completes Ironman Triathlon 22 Years After Surgery. The Journal of Heart and Lung Transplantation 28:4, 415
   CrossRef