Prognostic value of cardiopulmonary exercise testing in a European cohort with cardiovascular risk factors absent of a cardiovascular disease diagnosis.

Introduction: Cardiorespiratory fitness (CRF) is now considered a vital sign. Cardiopulmonary exercise testing (CPET) is the gold-standard assessment of CRF; peak oxygen consumption (VO ₂ ) and the minute ventilation/carbon dioxide production (VE/VCO ₂ ) slope are considered primary CPET measures of CRF. More work is needed to determine the role of this exercise assessment in the primary care setting.
Methods: 695 subjects (mean age: 62 ± 13 years, body mass index: 28.9 ± 5.3 kg/m ² , 375 female and 320 male) underwent CPET using a cycle ergometer. 95% of the cohort had one or more major cardiovascular risk factor (i.e., obesity, smoking, dyslipidemia, hypertension, diabetes); no subject was diagnosed with cardiovascular disease (CVD) at the time of CPET. Subjects were tracked for the composite endpoint of cardiovascular mortality or hospital admission.
Results: Mean peak VO ₂ , VE/VCO ₂ slope and peak respiratory exchange ratio were 17.8 ± 5.8 mlO ₂ •kg ^-1 •min ^-1 , 26.7 ± 4.1, and 1.18 ± 0.13, respectively. There were 42 composite events during the 64 ± 18 month tracking period. Both peak VO ₂ (Chi-square 16.3, p < 0.001) and the VE/VCO ₂ slope (Chi-square 14.9, p < 0.001) were significant univariate predictors of the composite endpoint. The VE/VCO ₂ slope added significant predictive value to peak VO ₂ and was retained in the multivariate regression (residual Chi-square 7.0, p = 0.008).
Discussion: These results support the prognostic value of CPET prior to a CVD diagnosis. The prognostic value of the VE/VCO ₂ slope, not commonly the focus of CPET trials in patients with one or more major cardiovascular risk factors but without a confirmed CVD diagnosis, is a particularly novel finding in the current study.
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