What peak VO2 level indicates a reasonable time to consider listing a patient for heart transplantation?

A peak VO2 level of less than 14 ml/kg/m² is widely recognized as a critical threshold in determining whether a patient with heart failure may benefit from listing for heart transplantation. This measure represents the maximum amount of oxygen the body can utilize during intense exercise and serves as a key indicator of a patient’s functional capacity and overall cardiovascular health.

When a patient's peak VO2 drops below this level, it typically signifies significant impairment in cardiovascular function and a limited ability to engage in physical activity. Patients with such diminished exercise capacity often experience severe symptoms of heart failure, marking their condition as advanced or refractory. It is in this where heart transplantation becomes a necessary consideration, as it can significantly enhance the quality of life and survival of patients who are not adequately managed with medical therapy alone.

Thresholds higher than 14 ml/kg/m² suggest better exercise tolerance and a potentially lower urgency for transplantation, as these patients might respond better to medical management or other interventions. Thus, the recognition of peak VO2 below this level acts as a critical decision point for healthcare providers in assessing urgency for transplant referral.