Key result
The determinants of peak oxygen uptake in heart disease patients varied by renal function stage, with ΔPETO2 being the strongest predictor in patients with eGFR 45-59 (β = 0.501, p < 0.001), whereas LVEF and hemoglobin were the primary determinants in those with eGFR <45.
Why the study?
Identifying the causes of low peak oxygen uptake in heart disease patients with renal dysfunction is necessary to guide prognostic improvement strategies.
What are the determinants of peak oxygen uptake in heart disease patients across different stages of renal dysfunction?
Observational (n=201)
No
What are the determinants of peak oxygen uptake in heart disease patients across different stages of renal dysfunction?
Effect estimate: β = 0.501 (95% CI 0.402, 1.013)
p-value: p=<0.001
The determinants of peak oxygen uptake in heart disease patients vary by renal function stage, with LVEF and hemoglobin being key in severe dysfunction and ΔPETO2 in moderate dysfunction.
May inform stage-specific CPET interpretation in cardiorenal disease; leaves open causal mechanisms and intervention effects.
Background: Identifying the causes of low peak oxygen uptake (peak V̇O2) in heart disease patients with renal dysfunction is necessary for prognostic improvement strategies. The purpose of this study was to verify the determinants of peak V̇O2 for each stage of renal function in heart disease patients, focusing on end-tidal oxygen partial pressure (PETO2). Methods: Two hundred fifty heart disease patients who underwent cardiopulmonary exercise testing (CPET) in our institution were consecutively enrolled. Patients were divided into three groups by their estimated glomerular filtration rate (eGFR): <45, 45–59 and ≥60 mL/min/1.73 m2. Patient characteristics and CPET parameters including ΔPETO2 (rest—anaerobic threshold) were compared between the groups. The relationship between ΔPETO2 and peak V̇O2 was also investigated for each group. Results: In total, 201 patients were analyzed. ΔPETO2 decreased with the deterioration of renal function (eGFR <45, 0.1 mmHg vs. eGFR 45–59, 2.4 mmHg vs. eGFR ≥60, 5.2 mmHg, p < 0.001). In the eGFR <45 group, left ventricular ejection fraction (LVEF) and hemoglobin (Hb) were significantly associated with peak V̇O2β = 0.518, p < 0.001 and β = 0.567, p < 0.001, respectively), whereas ΔPETO2 was not. In the eGFR 45–59 group, age, Hb, and ΔPETO2 showed a significant association with peak V̇O2 (β = –0.354, p = 0.006; β = 0.258, p = 0.007; β = 0.501, p < 0.001; respectively). In the univariate analysis, eGFR 45–59 group showed the highest coefficient of determination of ΔPETO2 to peak V̇O2 (R2 = 0.247, p < 0.001). Conclusions: The determinants of peak V̇O2 in heart disease patients depended on the stage of renal function. The determinants of peak V̇O2 in patients with eGFR <45 were LVEF and Hb, while ΔPETO2 was the strongest predictor of peak V̇O2 in patients with eGFR 45–59.
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Ogura et al. (2022) conducted an observational in Heart disease with renal dysfunction (n=201). End-tidal oxygen partial pressure (ΔPETO2) and renal dysfunction stage vs. Comparison across different eGFR strata (<45, 45-59, ≥60 mL/min/1.73 m2) was evaluated on Association of ΔPETO2 with peak oxygen uptake (peak VO2) in patients with eGFR 45-59 mL/min/1.73 m2 (β = 0.501, 95% CI 0.402, 1.013, p=<0.001). The determinants of peak oxygen uptake in heart disease patients varied by renal function stage, with ΔPETO2 being the strongest predictor in patients with eGFR 45-59 (β = 0.501, p < 0.001), whereas LVEF and hemoglobin were the primary determinants in those with eGFR <45.
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