Key result
Resting echocardiographic parameters independently explain ~19% of the variance in peak VO2.
Why the study?
Peak VO2, heart rate recovery, and ventilatory efficiency from CPET provide important cardiovascular fitness and prognostic data, but key resting echocardiographic predictors of these parameters in a general cardiology population remained to be identified.
Cohort (n=1,909)
No
Resting echocardiographic parameters, particularly markers of stroke volume and diastolic function, are significantly correlated with cardiopulmonary fitness and can predict nearly 20% of the variance in peak VO2 in a general cardiology population.
Resting LV mass and stroke volume indices were associated with peak VO2; leaves open whether they improve risk stratification or reduce CPET need.
Background/Objectives: The peak oxygen consumption (VO2) during cardiopulmonary exercise testing (CPET) is a strong predictor of all-cause mortality. The cardiac output, a key determinant of VO2, can be assessed using resting echocardiographic parameters. The heart rate recovery and ventilatory efficiency (VE/VCO2 slope) from CPET offer additional insights into cardiovascular fitness. Methods: This study aimed to identify resting echocardiographic parameters that predict the percentage of predicted peak VO2, heart rate recovery, and VE/VCO2 slope in a general cardiology population. This retrospective analysis included 1909 patients who underwent echocardiography within 3 months of CPET from 2017 to 2022. Patients with potentially confounding co-morbid conditions were removed. Spearman correlations were used to compare 19 echocardiographic parameters to peak VO2, heart rate recovery, and the VE/VCO2 slope, followed by multiple linear regression of peak VO2. Results: Eleven echocardiographic parameters correlated with peak VO2, with the strongest correlations seen with the left ventricular stroke volume index (R = 0.284, p < 0.001), mitral valve medial annular a’ wave velocity (R = 0.142, p < 0.0001), and mitral E-to-e’ ratio (R = −0.117, p < 0.0001). The left ventricular diastolic parameters and mitral E/A ratio correlated strongly with the heart rate recovery and VE/VCO2 slope. The multiple linear regression analysis identified the left ventricular mass index, stroke volume index, mitral valve E wave velocity, tricuspid valve regurgitation peak systolic velocity, tricuspid lateral annular systolic velocity S’, and left atrial volume index as independent predictors of peak VO2 (R2 = 0.191). Conclusions: The left ventricular stroke volume, diastolic function, and RV systolic function markers are significant predictors of cardiopulmonary fitness, aiding clinical decision-making in patients without CPET data.
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Chaliki et al. (2025) conducted a cohort in General cardiology patients undergoing cardiopulmonary exercise testing (n=1,909). Resting echocardiographic parameters (left ventricular stroke volume, diastolic function, RV systolic function) was evaluated on Percentage of predicted peak oxygen consumption (VO2) (R2 = 0.191 (multiple linear regression), p=<0.05). Resting echocardiographic parameters, notably left ventricular mass and stroke volume indices, combined to independently predict 19.1% of the variance in peak VO2 during cardiopulmonary exercise testing.
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