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)
Open accessAbstract
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 < or =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.
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Exercise time on a treadmill or cycle has high reproducibility and can easily be converted to distance.
“We prefer a simpler measure of direct patient relevance—exercise time on a treadmill or cycle—which has high reproducibility and can easily be converted to distance. 40”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [40]
The Methods describe measuring exercise time during treadmill and cycle tests, but the Results report that mean exercise time increased significantly on the second test; the Discussion attributes a familiarity effect to exercise time. The Discussion also cautions that findings may not apply to cycle ergometry, and no passage addresses converting exercise time to distance. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredBecause the coefficient of variation of peak VO2 is ≈6% to 7% in older patients with HF, an increase of >7% from baseline suggests a clinically meaningful improvement in aerobic capacity.
“Because the coefficient of variation of peak V˙o2 is ≈6% to 7% in older patients with HF,148,149 an increase of >7% from baseline suggests a clinically meaningful improvement in aerobic capacity.”
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“We prefer a simpler measure of direct patient relevance—exercise time on a treadmill or cycle— which has high reproducibility and can easily be converted to distance.(40)Exercise capacity is a common endpoint for interventions in CHF.”
Method
- Authors
- Bensimhon, D. R., Leifer, E. S., Ellis, S. J., Fleg, J. L., Keteyian, S. J., Piña, I. L., Kitzman, D. W., McKelvie, R. S., Kraus, W. E., Forman, D. E., Kao, A. J., Whellan, D. J., O'Connor, C. M., & Russell, S. D.
- Affiliations
- Cardiovascular Research Foundation (US)
- National Institutes of Health (US)
- Duke University (US)
- Henry Ford Health (US)
- Case Western Reserve University (US)
- Wake Forest University Health Sciences (US)
- Brigham and Women's Hospital (US)
- Thomas Jefferson University (US)
- Johns Hopkins University (US)
- Corresponding author
- Russell, Stuart D.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 102
- Issue
- 6
- Pages
- 712-717
- ISSN
- 0002-9149 (ISSN-L)
- PMC
- PMC2700047
- OpenAlex
- W2093004026
- Cited by
- 116
- References
- 17
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 10 · 2016: 8 · 2015: 9 · 2014: 7 · 2013: 6 · 2012: 11
- FWCI
- 25.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R37AG018915)
- National Heart, Lung, and Blood Institute (U01HL063747)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- peak oxygen uptake, heart failure, cardiopulmonary exercise testing, within-person variability, reproducibility, ventilatory threshold, exercise training, HF-ACTION trial, left ventricular ejection fraction
- MeSH terms
- Adult, Aged, Carbon Dioxide, Exercise Test, Female, Heart Failure, Humans, Male, Middle Aged, Oxygen Consumption, Pulmonary Ventilation, Stroke Volume, Reproducibility of Results
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