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Maximal exercise capacity expressed as metabolic equivalents (METs) is rarely directly measured (measured METs; mMETs) but estimated from maximal workload (estimated METs; eMETs). We assessed the accuracy of predicting mMETs by eMETs in asymptomatic subjects. Thirty-four healthy volunteers without cardiovascular risk factors (controls) and 90 patients with at least one risk factor underwent cardiopulmonary exercise testing using individualized treadmill ramp protocols. The equation of the American College of Sports Medicine (ACSM) was employed to calculate eMETs. Despite a close correlation between eMETs and mMETs (patients: r = 0.82, controls: r=0.88; p<0.00l for both), eMETs were higher than mMETs in both patients [11.7 (8.9- 13.4) vs. 8.2(7.0-10.6) METs; p <0.0011 and controls 117.0(16.2-18.2) vs. 15.6(14.2-17.0) METs; p<0.001]. The absolute [2.5 (1.6-3.7) vs. 1.3 (0.9-2.1) METs; p<0.001[ and the relative 128 (19-47) vs. 9 (6-14)%; p<0.0001] difference between eMETs and mMETs was higher in patients. In patients, ratio limits of agreement of 1.33 (*/÷ 1.40) between eMETs and mMETs were obtained, whereas the ratio limits of agreement were 1.09 (*/÷ 1.13) in controls. The ACSM equation is associated with a significant overestimation of mMETs in young and fit subjects, which is markedly more pronounced in older and less fit subjects with cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background: Incidence, predictors, and prognostic impact of worsening renal function (WRF) in elderly patients with chronic heart failure (HF) undergoing intensive contemporary medical therapy are unknown., Methods and Results: In 566 patients (age 77 ± 8 years) included in the TIME-CHF, serum creatinine (sCr) was repeatedly measured up to 6 months. Worsening renal function was classified as increase in sCr by 0.2 to 0.3 (WRFI), 0.3 to 0.5 (WRFII), or ≥0.5 mg/dL (WRFIII) within the first 6 months. Outcome events were assessed for 18 months., Results: The incidence of WRF I, II, and III was 12%, 19%, and 22%, respectively. Worsening renal function III was associated with increased mortality (hazard ratio 1.98 [95% CI 1.27-3.07, P = .002] vs no WRF), whereas WRF I/II was not. History of renal failure, spironolactone treatment, higher baseline dose, and higher maximal increase in loop diuretic dose were independently associated with the occurrence of WRF III, whereas angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, and β-blocker use and allocation to N-terminal pro-B-type natriuretic peptide-guided management were not. Worsening renal function III was an independent predictor of death, death or hospitalization, and death or HF hospitalization also after adjusting for baseline characteristics., Conclusions: One fifth of elderly patients with chronic HF experienced WRF III on 6-month intensive HF treatment. These patients had higher mortality, whereas patients with smaller sCr rises did not. Occurrence of WRF III was associated with high doses of loop diuretics and spironolactone use but not with other treatments., (Copyright © 2012 Mosby, Inc. All rights reserved.)