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CLINICAL STUDY: HEART FAILURE

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

^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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