Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Postbox 8905, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway.
Clinic of Cardiology, St. Olavs University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway.
Eur Heart J Cardiovasc Imaging. 2023 May 31;24(6):721-729. doi: 10.1093/ehjci/jead034.
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.
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.
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.
心血管结构会适应代谢需求，但目前基于体表面积的索引方法并不能准确反映这种变化。因此，我们旨在研究左心室舒张末期容积（LVEDV）和左心房最大容积（LAVmax）与绝对（L/min）峰值摄氧量（VO2peak）和去脂体重（FFM）的关系，与体表面积（BSA）相比。随后，我们评估了通过绝对 VO2peak、FFM 和 BSA 进行索引以区分病理性和生理性重塑的效果。
我们使用 1190 名健康成年人的数据，通过回归和相关分析探索了 BSA、FFM 和绝对 VO2peak 与 LVEDV 和 LAVmax 的关系。然后，我们使用卡方检验和 Fisher 精确检验以及净重新分类和综合判别指数，比较了这些索引方法对 61 例心力衰竭患者和 71 名耐力运动员的正常/病理分类。绝对 VO2peak 与 LVEDV 密切相关，解释了 52%的方差，而 BSA 为 32%，FFM 为 44%。在基于 BSA 索引的基础上，对 LVEDV 进行 VO2peak 索引可以提高心力衰竭患者和运动员之间的区分能力。18 名运动员中有 17 名基于 BSA 分类为病理的患者通过 VO2peak 索引重新分类为正常（P<0.001），而心力衰竭患者被重新分类为病理（39-95%，P<0.001）。所有索引方法在单变量模型中解释的 LAVmax 方差均低于 20%。
对 LVEDV 进行 VO2peak 索引可以提高区分生理性和病理性扩张的能力。LVEDV 与绝对 VO2peak 的比值可能是诊断心力衰竭和评估运动员心脏的关键指标。
