Published Online
on February 10, 2009

A more recent version of this article appeared on March 1, 2009

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Original Article

Determining the Preferred Percent-Predicted Equation for Peak Oxygen Consumption in Patients with Heart Failure

Ross Arena^1,7; Jonathan Myers²; Joshua Abella²; Sherry Pinkstaff¹; Peter Brubaker³; Brian Moore³; Dalane Kitzman³; Mary Ann Peberdy¹; Daniel Bensimhon⁴; Paul Chase⁴; Daniel Forman⁵; Erin West⁵ and Marco Guazzi⁶

¹ Virginia Commonwealth University;
² VA Palo Alto Health Care System;
³ Wake Forest University;
⁴ LeBauer Cardiovascular Research Foundation;
⁵ Brigham and Women's Hospital;
⁶ University of Milano, San Paolo Hospital

⁷ E-mail: raarena{at}vcu.edu

Background—Peak oxygen consumption (VO2) is routinely assessed in patients with heart failure (HF) undergoing cardiopulmonary exercise testing (CPX). The purpose of the present investigation is to determine the prognostic ability of several established peak VO₂ prediction equations in a large HF cohort.

Methods and Results—One thousand one hundred and sixty-five subjects (70% male, age: 57.0±13.8 years, ischemic etiology: 43%) diagnosed with HF underwent CPX. Percent-predicted peak VO₂ was calculated according to normative values proposed by Wasserman and Hansen (equation), Jones (equation), the Cooper Clinic (below low fitness threshold), a Veteran's Administration male referral data set (four equations) and the St. James Take Heart Project for women (equation). The prognostic significance of percent-predicted VO₂ values derived from the two latter, sex-specific equations were assessed collectively (VA-St. James). There were 179 major cardiac events (117 deaths, 44 heart transplantations and 18 left ventricular assist device implantations) during the two year tracking period (annual event rate: 10%). Measured peak VO₂ and all percent-predicted peak VO₂ calculations were significant univariate predictors of adverse events (Chi-square: 31.9, p<0.001) and added prognostic value to ventilatory efficiency (VE/VCO₂ slope), the strongest CPX predictor of adverse events (Chi-square: 150.7, p<0.001), in a multivariate regression. The Wasserman/Hansen prediction equation provided optimal prognostic information.

Conclusions—Actual peak VO₂ and the percent-predicted models included in this analysis all were significant predictors of adverse events. It appears that the percent-predicted peak VO₂ value derived from the Wasserman/Hansen equations may outperform other expressions of this CPX variable.

Key Words: aerobic capacity • exercise testing • outcome • ventilatory efficiency

Related Article

Determining the Preferred Percent-Predicted Equation for Peak Oxygen Consumption in Patients With Heart Failure

Ross Arena, Jonathan Myers, Joshua Abella, Sherry Pinkstaff, Peter Brubaker, Brian Moore, Dalane Kitzman, Mary Ann Peberdy, Daniel Bensimhon, Paul Chase, Daniel Forman, Erin West, and Marco Guazzi
Circ Heart Fail 2009 2: 113-120. [Abstract] [Full Text] [PDF]