Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation

Damiano Magrì, Piergiuseppe Agostoni, Ugo Corrà, Claudio Passino, Domenico Scrutinio, Pasquale Perrone-Filardi, Michele Correale, Gaia Cattadori, Marco Metra, Davide Girola, Massimo F. Piepoli, Annamaria Iorio, Michele Emdin, Rosa Raimondo, Federica Re, Mariantonietta Cicoira, Romualdo Belardinelli, Marco Guazzi, Giuseppe Limongelli, Francesco ClemenzaGianfranco Parati, Maria Frigerio, Matteo Casenghi, Angela B. Scardovi, Alessandro Ferraironi, Andrea Di Lenarda, Maurizio Bussotti, Anna Apostolo, Stefania Paolillo, Rocco La Gioia, Paola Gargiulo, Pietro Palermo, Chiara Minà, Stefania Farina, Elisa Battaia, Antonello Maruotti, Giuseppe Pacileo, Mauro Contini, Fabrizio Oliva, Roberto Ricci, Gianfranco Sinagra

Research output: Contribution to journalArticlepeer-review


Background: Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. Design: We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Methods: Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). Results: The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p=0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-index) similar to that obtained including VO2AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, β-blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO2AT cut-off for the SR group was 11.7 ml/kg/min, while it was 12.8 ml/kg/min for the AF group. Conclusions: VO2AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO2AT cut-off values between SR and AF HF patients should be adopted.

Original languageEnglish
Pages (from-to)1046-1055
Number of pages10
JournalEuropean Journal of Preventive Cardiology
Issue number8
Publication statusPublished - Aug 11 2015


  • anaerobic threshold
  • atrial fibrillation
  • exercise
  • Heart failure
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Epidemiology


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