Table 3. Universally accepted indications for cardiac transplantation.

HFrEF with persistent symptoms despite appropriate medical therapy and instrumental therapy
NYHA class IIIb–IV
LVEF <35%*
VO2max ≤12–14 mL/kg/min, or VO2max <50% predicted, or VE/VCO2 slope >35† in cardiopulmonary exercise test
Cardiogenic shock not anticipated to improve
Acute myocardial infarction
Acute myocarditis
Persistent angina without additional procedure or surgical options despite appropriate medical therapy, surgery, and procedure
Persistent ventricular arrhythmia despite use of antiarrhythmic agents or instruments or catheter ablation
Hypertrophic or restrictive cardiomyopathy with severe symptoms
Non-metastatic intracardiac tumor
Congenital heart disease without fixed pulmonary arterial hypertension

HFrEF = heart failure with reduced ejection fraction; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; VE/VCO₂ = minute ventilation/carbon dioxide production slope; VO₂max = maximal oxygen uptake.

^*Low LVEF alone is not an indication for cardiac transplant. ^†Abnormal cardiopulmonary exercise testing findings without abnormal findings in NYHA class is not an indication for cardiac transplant.