Prognostic value of peak work rate indexed by left ventricular diameter

Abstract

Left ventricular diameter (LVEDD) increases with systematic endurance training but also in various cardiac diseases. High exercise capacity associates with favorable outcomes. We hypothesized that peak work rate (Wpeak) indexed to LVEDD would carry prognostic information and aimed to evaluate the association between Wpeak/LVEDDrest and cardiovascular mortality. Wpeak/LVEDDrest (W/mm) was calculated in patients with an echocardiographic examination within 3 months of a maximal cycle ergometer exercise test. Low Wpeak/LVEDDrest was defined as a value below the sex- and age-specific 5th percentile among lower-risk subjects. The association with cardiovascular mortality was evaluated using Cox regression. In total, 3083 patients were included (8.0 [5.4–11.1] years of follow-up, 249 (8%) cardiovascular deaths). Wpeak/LVEDDrest (W/mm) was associated with cardiovascular mortality (adjusted hazard ratio (HR) 0.28 [0.22–0.36]), similar to Wpeak in % of predicted, with identical prognostic strength when adjusted for age and sex (C-statistics 0.87 for both). A combination of low Wpeak/LVEDDrest and low Wpeak was associated with a particularly poor prognosis (adjusted HR 6.4 [4.0–10.3]). Wpeak/LVEDDrest was associated with cardiovascular mortality but did not provide incremental prognostic value to Wpeak alone. The combination of a low Wpeak/LVEDDrest and low Wpeak was associated with a particularly poor prognosis.

The relationship between workload and exercise‐induced cardiac troponin elevations is influenced by non‐obstructive coronary atherosclerosis

“…Future studies need to explore the potential role of power output monitoring during exercise in guiding exercise intensity in individuals with CAD. These findings align with studies demonstrating a strong prognostic impact of power measurements in cardiac stress tests 32 . This study involved participants accustomed to high exertion levels over long periods without restrictions on their blood pressure or exercise intensity.…”

“…These findings align with studies demonstrating a strong prognostic impact of power measurements in cardiac stress tests. 32 This study involved participants accustomed to high exertion levels over long periods without restrictions on their blood pressure or exercise intensity. The study included continuous power meter measurements and blood pressure recording during exercise, allowing more precise assessments of the participants' efforts during exercise.…”