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Challenges with Percent Predicted Maximum VO2 in Patients with Heart Failure

Brawner Clinton A.; Ehrman, Jonathan K.; Shafiq, Ali; Saval, Matthew A.; Russell, Stuart D.; Lanfear, David E.; Keteyian, Steven J.
Medicine & Science in Sports & Exercise: Post Acceptance: September 21, 2017
doi: 10.1249/MSS.0000000000001431
Original Investigation: PDF Only

ABSTRACTPurposeTo describe the influence of different equations to predict maximum oxygen uptake (MVO2) on the percent predicted MVO2 (ppMVO2) and the resultant categorization of patients with heart failure with reduced ejection fraction (HFrEF) into high or low risk.MethodsIn this retrospective cohort study, ppMVO2 was calculated using six different equations to predict MVO2 among 1,168 patients with HFrEF (33% women). Repeated measures analysis of variance was used to compare within-subject differences in mean ppMVO2 between the prediction equations. Cochrane’s Q test was used to compare the within-subject difference in the proportion of patients with ppMVO2 <50% (high risk) and ≥75% (low risk) between the five prediction equations.ResultsThe ppMVO2 varied significantly (P<.001) between the MVO2 prediction equations with mean (10th, 90th percentile) ppMVO2 ranging from 39% (25%, 54%) to 60% (39%, 83%) in men and 37% (24%, 49%) to 70% (47%, 94%) in women. Significant variation (P<.001) was also observed between prediction equations for the proportion of patients with ppMVO2 <50% and ≥75% in men and women.ConclusionsStatistically significant and clinically meaningful variations in the ppMVO2 are observed based on the reference equation used to predict MVO2. Future writing committees should specify the preferred reference equation when identifying a ppMVO2 criterion in guideline statements.

Purpose

To describe the influence of different equations to predict maximum oxygen uptake (MVO2) on the percent predicted MVO2 (ppMVO2) and the resultant categorization of patients with heart failure with reduced ejection fraction (HFrEF) into high or low risk.

Methods

In this retrospective cohort study, ppMVO2 was calculated using six different equations to predict MVO2 among 1,168 patients with HFrEF (33% women). Repeated measures analysis of variance was used to compare within-subject differences in mean ppMVO2 between the prediction equations. Cochrane’s Q test was used to compare the within-subject difference in the proportion of patients with ppMVO2 <50% (high risk) and ≥75% (low risk) between the five prediction equations.

Results

The ppMVO2 varied significantly (P<.001) between the MVO2 prediction equations with mean (10th, 90th percentile) ppMVO2 ranging from 39% (25%, 54%) to 60% (39%, 83%) in men and 37% (24%, 49%) to 70% (47%, 94%) in women. Significant variation (P<.001) was also observed between prediction equations for the proportion of patients with ppMVO2 <50% and ≥75% in men and women.

Conclusions

Statistically significant and clinically meaningful variations in the ppMVO2 are observed based on the reference equation used to predict MVO2. Future writing committees should specify the preferred reference equation when identifying a ppMVO2 criterion in guideline statements.

Address for Correspondence: Clinton A. Brawner, PhD, Preventive Cardiology, Henry Ford Hospital, 6525 Second Ave. Detroit, Michigan, 48202 (USA), 01.313.972.4108 (voice); 01.313.972.1921 (fax). Cbrawne1@hfhs.org

The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. These results do not constitute endorsement by ACSM. No external financial support was received for this analysis. Drs. Brawner, Keteyian, and Ehrman operate an exercise testing data core laboratory for multi-site clinical trials. These services are provided based on a fee-for-service agreement between the sponsor and Henry Ford Health System. These include active service agreements with Actelion, Alnylam, and Heart Metabolics. The authors have no other conflicts or financial disclosures.

Accepted for Publication: 18 September 2017

© 2017 American College of Sports Medicine