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. 2010 Dec 16;12(1):74.
doi: 10.1186/1532-429X-12-74.

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Henrik Engblom  1 , Katarina Steding, Marcus Carlsson, Henrik Mosén, Bo Hedén, Torsten Buhre, Björn Ekmehag, Håkan Arheden
Affiliations

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Henrik Engblom et al. J Cardiovasc Magn Reson. .

Abstract

Background: An early sign of heart failure (HF) is a decreased cardiac reserve or inability to adequately increase cardiac output during exercise. Under normal circumstances maximal cardiac output is closely related to peak oxygen uptake (VO2peak) which has previously been shown to be closely related to total heart volume (THV). Thus, the aim of this study was to derive a VO2peak/THV ratio and to test the hypothesis that this ratio can be used to distinguish patients with HF from healthy volunteers and endurance athletes. Thirty-one patients with HF of different etiologies were retrospectively included and 131 control subjects (60 healthy volunteers and 71 athletes) were prospectively enrolled. Peak oxygen uptake was determined by maximal exercise test and THV was determined by cardiovascular magnetic resonance. The VO2peak/THV ratio was then derived and tested.

Results: Peak oxygen uptake was strongly correlated to THV (r2 = 0.74, p < 0.001) in the control subjects, but not for the patients (r2 = 0.0002, p = 0.95). The VO2peak/THV ratio differed significantly between control subjects and patients, even in patients with normal ejection fraction and after normalizing for hemoglobin levels (p < 0.001). In a multivariate analysis the VO2peak/THV ratio was the only independent predictor of presence of HF (p < 0.001).

Conclusions: The VO2peak/THV ratio can be used to distinguish patients with clinically diagnosed HF from healthy volunteers and athletes, even in patients with preserved systolic left ventricular function and after normalizing for hemoglobin levels.

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Figures

Figure 1
Figure 1
Delineation of total heart volume. Example of delineation of the pericardium from short-axis cardiac magnetic resonance images enabling determination of the total heart volume. The base is seen in the upper left corner and apex in the lower right corner. Ao = ascending aorta, LA = left atrium, LV = left ventricle, Pulm = pulmonary artery, RA = right atrium, RV = right ventricle.
Figure 2
Figure 2
Peak oxygen uptake in relation to total heart volume and body weight. Peak oxygen uptake (VO2peak) in comparison to A) total heart volume (THV) and B) body weight. Filled circles denote control subjects, including healthy volunteers and athletes and open circles denote heart failure patients. Solid lines represent the regression line and dashed lines the 95% confidence interval. In the control group there was a strong correlation between VO2peak and THV. Even though there was also a significant correlation between VO2peak and body weight, there was a considerable variation of VO2peak for a given body weight.
Figure 3
Figure 3
Left ventricular ejection fraction in relation to VO2peak/THV ratio. Left ventricular ejection fraction (LVEF) for A) all subjects and B) control subjects and heart failure patients with LVEF > 50% and C) VO2peak/THV ratio for the control subjects and heart failure patients with LVEF > 50%. In the heart failure patients with LVEF > 50% there was a significantly lower VO2peak/THV ratio despite a slightly higher LVEF compared to the control subjects. The solid line represents the mean value. * p < 0.05 and *** p < 0.001
Figure 4
Figure 4
VO2peak/THV ratio in heart failure patients and control subjects. VO2peak/THV ratio in heart failure patients compared to healthy volunteers and different groups of athletes. The VO2peak/THV ratio was significantly lower in the heart failure patients compared to the control groups (A). This relationship remained unchanged after normalizing the results to hemoglobin levels (B). The solid line represents the mean value. ** p < 0.01 and *** p < 0.001 compared to healthy volunteers.
Figure 5
Figure 5
Peak oxygen uptake in comparison to VO2peak/THV ratio. Peak oxygen uptake (VO2peak) for the healthy volunteers and the HF patients (A) which showed a considerable overlap (B). The VO2peak/THV ratio was, however, significantly lower in the 10 heart failure patients compared to the 10 healthy volunteers with overlapping VO2peak (C). Dashed lines indicate the overlap between the two groups and the solid lines represents mean values. *** p < 0.001
Figure 6
Figure 6
VO2peak/THV ratio in different age groups. VO2peak/THV ratio in healthy volunteers and in heart failure patients in different age groups. Even though there was a slight decrease in VO2peak/THV ratio with increasing age in the healthy volunteers, VO2peak/THV ratio remained significantly higher in the healthy volunteers compared to the heart failure patients. * p < 0.05 and *** p < 0.001
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