title: Does peak oxygen pulse complement peak oxygen uptake in risk stratifying patients with heart failure?
abstract: There is scarce information regarding the prognostic utility of peak exercise oxygen pulse (peak O(2) pulse), a surrogate for stroke volume, in patients with heart failure (HF). From May 1994 to November 2007, 998 patients with HF underwent cardiopulmonary exercise testing. The ability of peak oxygen uptake (VO(2)) and peak O(2) pulse to predict cardiac events was examined. Peak O(2) pulse was calculated by dividing peak VO(2) by heart rate at the time peak VO(2) was achieved and was expressed in both milliliters per beat and as a percentage achieved of the age-predicted value. There were 212 cardiac events (176 deaths, 26 transplantations, and 10 left ventricular assist device implantations) over a mean of 28 +/- 26 months of follow-up. Peak VO(2) and age-predicted peak O(2) pulse were demonstrated by univariate and multivariate Cox regression analyses to be independent predictors of mortality (p <0.001). The optimal cut points for peak VO(2) and age-predicted peak O(2) pulse (<14.3 and > or =14.3 [mL/kg(-1)/min(-1)] and <85% and > or =85%, respectively) were established by areas under the receiver-operating characteristic curves. Patients exhibiting abnormalities for both responses had 4.8-fold (95% confidence interval 2.7 to 8.5) and 6.7-fold (95% confidence interval 4.1 to 11.1) higher risks for mortality and cardiac events, respectively, than those whose responses were normal. Age-predicted peak O(2) pulse also predicted mortality in patients in the intermediate range of peak VO(2) (10 to 14 (mL/kg(-1)/min(-1))). The 3-year mortality rate for patients in this range who had age-predicted peak O(2) pulse values <85% was even slightly higher than those with peak VO(2) <10.1 (mL/kg(-1)/min(-1)). In conclusion, age-predicted peak O(2) pulse was a strong and independent predictor of cardiac mortality and complemented peak VO(2) in predicting risk in patients with HF.
authors: Gama Filho University, Rio de Janeiro, Brazil. ricardobrandaorj@gmail.com
authors: Ricardo B
authors: RB
authors: Oliveira
authors: Jonathan
authors: J
authors: Myers
authors: Claudio Gil S
authors: CG
authors: Araújo
authors: Ross
authors: R
authors: Arena
authors: Sandra
authors: S
authors: Mandic
authors: Daniel
authors: D
authors: Bensimhon
authors: Joshua
authors: J
authors: Abella
authors: Paul
authors: P
authors: Chase
authors: Marco
authors: M
authors: Guazzi
authors: Peter
authors: P
authors: Brubaker
authors: Brian
authors: B
authors: Moore
authors: Dalane
authors: D
authors: Kitzman
authors: Mary Ann
authors: MA
authors: Peberdy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis