Indexing Cardiac Volumes for Peak Oxygen Uptake to Improve Differentiation of Physiological and Pathological Remodeling: from Elite Athletes to Heart Failure Patients

Overview

Journal Eur Heart J Cardiovasc Imaging

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Radiology

Date 2023 Apr 19

PMID 37073553

Authors

Jon Magne Letnes

Bjarne Martens Nes

Knut Asbjorn Rise Langlo

Inger-Lise Aamot Aksetoy

Kari Margrethe Lundgren

Knut Skovereng

Oyvind Sandbakk

Ulrik Wisloff

Havard Dalen

Affiliations

Soon will be listed here.

Abstract

Aims: Cardiovascular structures adapt to meet metabolic demands, but current methodology for indexing by body size does not accurately reflect such variations. Therefore, we aimed to investigate how left ventricular end-diastolic volume (LVEDV) and left atrial maximal volume (LAVmax) are associated with absolute (L/min) peak oxygen uptake (VO2peak) and fat-free mass (FFM) compared to body surface area (BSA). We subsequently assessed the impact of indexing by absolute VO2peak, FFM, and BSA to discriminate pathological from physiological remodeling.

Methods And Results: We used data from 1190 healthy adults to explore relationships for BSA, FFM, and absolute VO2peak with LVEDV and LAVmax by regression and correlation analyses. We then compared these indexing methods for classification to normalcy/pathology in 61 heart failure patients and 71 endurance athletes using the chi-squared and Fisher exact tests and the net reclassification and integrated discrimination indices. Absolute VO2peak correlated strongly with LVEDV, explaining 52% of variance vs. 32% for BSA and 44% for FFM. Indexing LVEDV for VO2peak improved discrimination between heart failure patients and athletes on top of indexing to BSA. Seventeen out of 18 athletes classified to pathology by BSA were reclassified to normalcy by VO2peak indexing (P < 0.001), while heart failure patients were reclassified to pathology (39-95%, P < 0.001). All indexing methods explained below 20% of the variance in LAVmax in univariate models.

Conclusions: Indexing LVEDV to VO2peak improves the ability to differentiate physiological and pathological enlargement. The LVEDV to absolute VO2peak ratio may be a key index in diagnosing heart failure and evaluating the athlete's heart.

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References

Hittner J, May K, Silver N . A Monte Carlo evaluation of tests for comparing dependent correlations. J Gen Psychol. 2003; 130(2):149-68. DOI: 10.1080/00221300309601282. View

Langlo K, Lundgren K, Zanaboni P, Mo R, Ellingsen O, Hallan S . Cardiorenal syndrome and the association with fitness: Data from a telerehabilitation randomized clinical trial. ESC Heart Fail. 2022; 9(4):2215-2224. PMC: 9288747. DOI: 10.1002/ehf2.13985. View

Rundqvist L, Engvall J, Faresjo M, Carlsson E, Blomstrand P . Regular endurance training in adolescents impacts atrial and ventricular size and function. Eur Heart J Cardiovasc Imaging. 2016; 18(6):681-687. DOI: 10.1093/ehjci/jew150. View

Sundstrom J, Byberg L, Gedeborg R, Michaelsson K, Berglund L . Useful tests of usefulness of new risk factors: tools for assessing reclassification and discrimination. Scand J Public Health. 2011; 39(4):439-41. DOI: 10.1177/1403494810396556. View

Letnes J, Dalen H, Aspenes S, Salvesen O, Wisloff U, Nes B . Age-related change in peak oxygen uptake and change of cardiovascular risk factors. The HUNT Study. Prog Cardiovasc Dis. 2020; 63(6):730-737. DOI: 10.1016/j.pcad.2020.09.002. View

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3):233-70. DOI: 10.1093/ehjci/jev014. View

Bjerring A, Landgraff H, Stokke T, Murbraech K, Leirstein S, Aaeng A . The developing athlete's heart: a cohort study in young athletes transitioning through adolescence. Eur J Prev Cardiol. 2019; 26(18):2001-2008. DOI: 10.1177/2047487319862061. View

Iskandar A, Mujtaba M, Thompson P . Left Atrium Size in Elite Athletes. JACC Cardiovasc Imaging. 2015; 8(7):753-62. DOI: 10.1016/j.jcmg.2014.12.032. View

Tsang T, Barnes M, Gersh B, Bailey K, Seward J . Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002; 90(12):1284-9. DOI: 10.1016/s0002-9149(02)02864-3. View

10.

La Gerche A, Burns A, Taylor A, MacIsaac A, Heidbuchel H, Prior D . Maximal oxygen consumption is best predicted by measures of cardiac size rather than function in healthy adults. Eur J Appl Physiol. 2011; 112(6):2139-47. DOI: 10.1007/s00421-011-2184-9. View

11.

Engblom H, Steding K, Carlsson M, Mosen H, Heden B, Buhre T . Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes. J Cardiovasc Magn Reson. 2010; 12:74. PMC: 3022802. DOI: 10.1186/1532-429X-12-74. View

12.

Pathak R, Elliott A, Middeldorp M, Meredith M, Mehta A, Mahajan R . Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study. J Am Coll Cardiol. 2015; 66(9):985-96. DOI: 10.1016/j.jacc.2015.06.488. View

13.

Pelliccia A, Caselli S, Sharma S, Basso C, Bax J, Corrado D . European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the.... Eur Heart J. 2017; 39(21):1949-1969. DOI: 10.1093/eurheartj/ehx532. View

14.

Asvold B, Langhammer A, Rehn T, Kjelvik G, Grontvedt T, Sorgjerd E . Cohort Profile Update: The HUNT Study, Norway. Int J Epidemiol. 2022; 52(1):e80-e91. PMC: 9908054. DOI: 10.1093/ije/dyac095. View

15.

Steding K, Engblom H, Buhre T, Carlsson M, Mosen H, Wohlfart B . Relation between cardiac dimensions and peak oxygen uptake. J Cardiovasc Magn Reson. 2010; 12:8. PMC: 2825210. DOI: 10.1186/1532-429X-12-8. View

16.

Nistri S, Galderisi M, Ballo P, Olivotto I, DAndrea A, Pagliani L . Determinants of echocardiographic left atrial volume: implications for normalcy. Eur J Echocardiogr. 2011; 12(11):826-33. DOI: 10.1093/ejechocard/jer137. View

17.

Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G . Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging. 2014; 15(6):680-90. PMC: 4402333. DOI: 10.1093/ehjci/jet284. View

18.

Letnes J, Eriksen-Volnes T, Nes B, Wisloff U, Salvesen O, Dalen H . Variability of echocardiographic measures of left ventricular diastolic function. The HUNT study. Echocardiography. 2021; 38(6):901-908. DOI: 10.1111/echo.15073. View

19.

Davis E, Crousillat D, He W, Andrews C, Hung J, Danik J . Indexing Left Atrial Volumes: Alternative Indexing Methods Better Predict Outcomes in Overweight and Obese Populations. JACC Cardiovasc Imaging. 2022; 15(6):989-997. DOI: 10.1016/j.jcmg.2022.02.006. View

20.

McNamara D, Aiad N, Howden E, Hieda M, Link M, Palmer D . Left Atrial Electromechanical Remodeling Following 2 Years of High-Intensity Exercise Training in Sedentary Middle-Aged Adults. Circulation. 2018; 139(12):1507-1516. PMC: 6422706. DOI: 10.1161/CIRCULATIONAHA.118.037615. View