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.