Reproducibility of Peak Oxygen Uptake and Other Cardiopulmonary Exercise Testing Parameters in Patients With Heart Failure (from the Heart Failure and A Controlled Trial Investigating Outcomes of exercise traiNing)

doi:10.1016/j.amjcard.2008.04.047

The American Journal of Cardiology

Volume 102, Issue 6, 15 September 2008, Pages 712-717

https://doi.org/10.1016/j.amjcard.2008.04.047 Get rights and content

Peak oxygen uptake (pVo₂) is an important parameter in assessing the functional capacity and prognosis of patients with heart failure. In heart failure trials, change in pVo₂ was often used to assess the effectiveness of an intervention. However, the within-subject variability of pVo₂ on serial testing may limit its usefulness. This study was designed to evaluate the within-subject variability of pVo₂ over 2 baseline cardiopulmonary exercise tests. As a substudy of the HF-ACTION trial, 398 subjects (73% men, 27% women; mean age 59 years) with heart failure and left ventricular ejection fraction ≤35% underwent 2 baseline cardiopulmonary exercise tests within 14 days. Mean pVo₂ was unchanged from test 1 to test 2 (15.16 ± 4.97 vs 15.18 ± 4.97 ml/kg/min; p = 0.78). However, mean within-subject absolute change was 1.3 ml/kg/min (10th, 90th percentiles 0.1, 3.0), with 46% of subjects increasing and 48% decreasing on the second test. Other parameters, including the ventilation-to-carbon-dioxide production slope and Vo₂ at ventilatory threshold, also showed significant within-subject variation with minimal mean differences between tests. In conclusion, pVo₂ showed substantial within-subject variability in patients with heart failure and should be taken into account in clinical applications. However, on repeated baseline cardiopulmonary exercise tests, there appears to be no familiarization effect for Vo₂ in patients with HF. Therefore, in multicenter trials, there is no need to perform >1 baseline cardiopulmonary exercise test.

Section snippets

Methods

Enrollment criteria and study design for the HF-ACTION have been previously published.¹ Subjects had a left ventricular ejection fraction ≤35% (caused by ischemic or nonischemic cardiomyopathy) and were on stable doses (i.e., the same dose for ≥6 weeks before enrollment) of optimal drug therapy, including an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and a β blocker unless a contraindication was present. Of subjects enrolled in HF-ACTION, 94% were using an

Results

Table 1 lists baseline demographics and pVo₂ for the 398 subjects in the study. On the first cardiopulmonary exercise test, mean pVo₂ was 15.2 ± 5.0 ml/kg/min.

As listed in Table 2, mean exercise time increased significantly from test 1 to test 2. Conversely, mean pVo₂ was virtually identical on the 2 tests. pVo₂ was nearly as likely to increase from test 1 to test 2 (46% of subjects) as it was to decrease (48% of subjects). Moreover, pVo₂ had substantial within-subject variability, averaging

Discussion

As a prespecified substudy of the HF-ACTION, we evaluated the reproducibility of pVo₂ and other important cardiopulmonary exercise parameters in 398 subjects with HF who underwent 2 tests within 14 days of each other to assess the need for repeated baseline testing in all subjects. The major findings were (1) significant within-subject variability in pVo₂ between the 2 tests (average coefficient of variation 6.6%), but the mean was the same between the 2 tests; (2) similar variability in other

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: This work was supported by Grant No. 5U01HL063747 from the National Institutes of Health, Bethesda, Maryland.

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Heart failureReproducibility of Peak Oxygen Uptake and Other Cardiopulmonary Exercise Testing Parameters in Patients With Heart Failure (from the Heart Failure and A Controlled Trial Investigating Outcomes of exercise traiNing)

Section snippets

Methods

Results

Discussion

Am Heart J

Chest

Chest

J Heart Lung Transplant

Chest

Am Heart J

Am J Cardiol

Heart failure
Reproducibility of Peak Oxygen Uptake and Other Cardiopulmonary Exercise Testing Parameters in Patients With Heart Failure (from the Heart Failure and A Controlled Trial Investigating Outcomes of exercise traiNing)