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.