Prognostic value of peak work rate indexed by left ventricular diameter

Left ventricular diameter (LVEDD) increases with systematic endurance training but also in various cardiac diseases. High exercise capacity associates with favorable outcomes. We hypothesized that peak work rate (W(peak)) indexed to LVEDD would carry prognostic information and aimed to evaluate the association between W(peak)/LVEDD(rest) and cardiovascular mortality. W(peak)/LVEDD(rest) (W/mm) was calculated in patients with an echocardiographic examination within 3 months of a maximal cycle ergometer exercise test. Low W(peak)/LVEDD(rest) was defined as a value below the sex- and age-specific 5th percentile among lower-risk subjects. The association with cardiovascular mortality was evaluated using Cox regression. In total, 3083 patients were included (8.0 [5.4–11.1] years of follow-up, 249 (8%) cardiovascular deaths). W(peak)/LVEDD(rest) (W/mm) was associated with cardiovascular mortality (adjusted hazard ratio (HR) 0.28 [0.22–0.36]), similar to W(peak) in % of predicted, with identical prognostic strength when adjusted for age and sex (C-statistics 0.87 for both). A combination of low W(peak)/LVEDD(rest) and low W(peak) was associated with a particularly poor prognosis (adjusted HR 6.4 [4.0–10.3]). W(peak)/LVEDD(rest) was associated with cardiovascular mortality but did not provide incremental prognostic value to W(peak) alone. The combination of a low W(peak)/LVEDD(rest) and low W(peak) was associated with a particularly poor prognosis.