(Circulation. 2000;101:1080.)
© 2000 American Heart Association, Inc.
Editorial |
Peak 
O2
A Simple yet Enduring Standard
From the Divisions of Circulatory Physiology and Cardiology, Columbia Presbyterian Medical Center, New York (D.M.); the Albert Einstein College of Medicine, Bronx, New York (T.J.); and the University of Michigan, Ann Arbor (K.A.).
Correspondence to Donna Mancini, MD, 622 West 168th St, Ph-14 West, New York, NY 10032. E-mail dmm31@columbia.edu
Key Words: exercise • heart failure • prognosis • transplantation
In this issue of Circulation, Pardaens et
al1 examine the prognostic value of
cardiopulmonary exercise testing in ambulatory patients with
heart failure who are screened for cardiac transplantation. The
investigators failed to demonstrate any significant advantage of
ventilatory data over peak oxygen uptake
(O2). Over the past 10 years,
several investigators have attempted to refine the use of peak
O2 to improve its prognostic
yield. Others have sought methods or equations to estimate peak
O2 from submaximal data, such
as that collected from 6-minute walk tests or during low-level
exercise. Most investigators have concluded that the straightforward
measurement of peak O2
provides the best index of prognosis in patients with ambulatory heart
failure.
The measurement of oxygen consumption
(O2) in patients with heart
failure was first described by Weber et al2 as a
noninvasive method for characterizing cardiac reserve and functional
status in these patients. Its use as a prognostic tool has evolved.
Szlachcic et al3 initially described the prognostic use of
peak O2 in a group of 27
patients. The 1-year mortality rate was 77% for patients with a peak
O2<10 mL ·
kg-1 · min-1 and
21% for those with a peak O2
of 10 to 18 mL · kg-1 ·
min-1. Likoff et al4 reported a
36% mortality rate in 201 patients with heart failure who had a peak
O2
13 mL ·
kg-1 · min-1; the
mortality rate was 15% when peak
O2 exceeded 13 mL ·
kg-1
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