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(Circulation. 2000;101:1152.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Peak Oxygen Uptake Better Predicts Outcome Than Submaximal Respiratory Data in Heart Transplant Candidates

Karel Pardaens, PhD; Johan Van Cleemput, MD; Johan Vanhaecke, MD, PhD; Robert H. Fagard, MD, PhD

From the Hypertension and Cardiovascular Rehabilitation Unit (K.P., R.H.F.) and Cardiology Unit (J.V.C., J.V.), Department of Molecular and Cardiovascular Research, Faculty of Medicine, University of Leuven, KUL, Leuven, Belgium.

Correspondence to K. Pardaens, PhD, Functiemetingen Cardiologie, Secretariaat Hypertensie, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.

Background—Many studies have focused on the prognostic power of peak oxygen uptake (O₂) in patients with chronic heart failure, but maximal exercise testing is not without risk. The purpose of the present study was, therefore, to assess the prognostic significance of the steepness of changes in ventilation and carbon dioxide output (CO₂) during submaximal exercise in comparison with O₂.

Methods and Results—The study population consisted of 284 adult heart transplant candidates who performed a graded maximal bicycle ergometer test with respiratory gas analysis. Using the respiratory data up to a gas exchange ratio of 1.0, 3 submaximal slopes were calculated in each patient. During follow-up (median, 1.33 years), 57 patients died and 149 had 1 cardiovascular event. When using Cox proportional hazards analysis, both peak O₂ and submaximal respiratory slopes predicted outcome before and after accounting for age, sex, and body mass index. However, whereas the prognostic power of peak O₂ was independent of submaximal respiratory data, the prognostic significance of the slopes was lost after controlling for peak O₂. Stepwise regression analysis even selected peak O₂ as an independent prognostic index among the following factors: cause of heart failure, ejection fraction, pulmonary vascular resistance, natremia, and the forced expiratory volume in 1 s.

Conclusions—Respiratory data during submaximal exercise are significant predictors of outcome in patients with chronic heart failure, but their prognostic power is inferior to that of peak O₂. However, these data may be useful when maximal exercise is contraindicated or not achievable.

Key Words: exercise • heart failure • prognosis • transplantation

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