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J Am Coll Cardiol, 2000; 36:2126-2131
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDY: HEART FAILURE

The incremental prognostic importance of body fat adjusted peak oxygen consumption in chronic heart failure

Ahmed F. Osman, MDa, Mandeep R. Mehra, MD, FACCa, Carl J. Lavie, MD, FACCa, Eduardo Nunez, MDa and Richard V. Milani, MD, FACCa

a Department of Cardiovascular Diseases, Ochsner Medical Institutions, New Orleans, Louisiana, USA

Manuscript received March 9, 2000; revised manuscript received May 19, 2000, accepted July 13, 2000.

Reprint requests and correspondence: Dr. Richard V. Milani, Department of Cardiology, Ochsner Medical Institutions, 1514 Jefferson Highway, New Orleans, Louisiana 70121
rmilani{at}ochsner.org

OBJECTIVES

We sought to assess whether the adjustment of peak oxygen consumption (PkVO2) to lean body mass would yield a more accurate discriminator of outcomes in the chronic heart failure population.

BACKGROUND

Peak oxygen consumption is traditionally used to risk stratify patients with congestive heart failure (CHF) and to time cardiac transplantation. There is, however, considerable variability in body fat content, which represents metabolically inactive mass.

METHODS

In 225 consecutive patients with CHF, the percentage of body fat was determined by the sum of skinfolds technique. All underwent CPX using a ramping treadmill protocol. Mean follow-up duration was 18.9 ± 11.3 months.

RESULTS

There were 14 cardiovascular deaths and 15 transplants. Peak oxygen consumption lean, both as a continuous variable and using a cutoff of ≤19 ml/kg/min, was a better predictor of outcome than unadjusted PkVO2 (p = 0.003 vs. 0.027 for the continuous variables and p = 0.0006 vs. 0.055 for ≤19 ml/kg/min and ≤14 ml/kg/min unadjusted body weight, respectively). Using partial correlation index R statistics, the Cox model using PkVO2 lean ≤19 ml/kg/min, in addition to age and etiology of CHF as covariates, yielded the strongest predictive relationship to the combined end point (chi-square value 24.32). Especially in the obese patients and in women, there was considerably better correlation of PkVO2 lean with outcome than the unadjusted PkVO2.

CONCLUSIONS

The adjustment of PkVO2 to lean body mass increases the prognostic value of cardiopulmonary stress testing in the evaluation of patients with chronic heart failure. The use of <19 ml O2/kg of lean body mass/min as a cutoff in PkVO2 should be used for timing transplantation, particularly in women and the obese.

Abbreviations and Acronyms
  AT = Anaerobic Threshold
  CHF = Congestive Heart Failure
  LBM = Lean Body Mass
  MVV = Maximal Voluntary Ventilation
  NPP = Negative Predictive Value
  NYHA = New York Heart Association
  PkVO2 = peak oxygen consumption
  PPV = Positive Predictive Value
  TX = Urgent Transplantation
  VE = Maximal Minute Ventilation
  VO2 = Oxygen Consumption




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