Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Abstract

BackgroundAn early sign of heart failure (HF) is a decreased cardiac reserve or inability to adequately increase cardiac output during exercise. Under normal circumstances maximal cardiac output is closely related to peak oxygen uptake (VO2peak) which has previously been shown to be closely related to total heart volume (THV). Thus, the aim of this study was to derive a VO2peak/THV ratio and to test the hypothesis that this ratio can be used to distinguish patients with HF from healthy volunteers and endurance athletes. Thirty-one patients with HF of different etiologies were retrospectively included and 131 control subjects (60 healthy volunteers and 71 athletes) were prospectively enrolled. Peak oxygen uptake was determined by maximal exercise test and THV was determined by cardiovascular magnetic resonance. The VO2peak/THV ratio was then derived and tested.ResultsPeak oxygen uptake was strongly correlated to THV (r2 = 0.74, p < 0.001) in the control subjects, but not for the patients (r2 = 0.0002, p = 0.95). The VO2peak/THV ratio differed significantly between control subjects and patients, even in patients with normal ejection fraction and after normalizing for hemoglobin levels (p < 0.001). In a multivariate analysis the VO2peak/THV ratio was the only independent predictor of presence of HF (p < 0.001).ConclusionsThe VO2peak/THV ratio can be used to distinguish patients with clinically diagnosed HF from healthy volunteers and athletes, even in patients with preserved systolic left ventricular function and after normalizing for hemoglobin levels.

European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart

“…Moreover, in doubtful cases, the assessment of peak oxygen uptake, which is consistently increased in relation to total heart volume can also help us to distinguish between physiologic and pathologic LV dilatation. 158 Finally, STE might give additional information in terms of myocardial contraction. However, only few studies are available to date with somewhat diverse results on LV function at rest.…”

Atrial remodelling is less pronounced in female endurance-trained athletes compared with that in male athletes

“…Several studies of left and right ventricular volumes in athletes have shown physiological adaptation to training that differs from the pathological remodeling found in diseases such as hypertrophic and dilated cardiomyopathies (1)(2)(3)(4)(5). Furthermore, total heart volume (THV) has been shown to increase with long term endurance training, and there is a strong correlation between THV and peak oxygen uptake (VO 2 peak) (4).…”

Cardiac Contractile Reserve Parameters Are Related to Prognosis in Septic Shock

“…Data from the SHOCK trial registry demonstrated that, at inclusion, a low cardiac power output <0.53 W accurately predicted in-hospital mortality [5]. As expected, the mean value of CPI was extremely low at inclusion in cardiogenic shock (0.22 ± 0.08 W/m 2    versus   0.62 ± 0.08 W/m 2 in healthy subjects) while elevated in initial septic shock (0.8 ± 0.13 W/m 2 ) [12, 13]. …”