Abstract
Background: Exercise capacity is known to be an independent predictor of cardiovascular events and mortality. However, most of previous studies were based on western population. Further study is warranted for Asian patients according to ethnic or national standard. We aimed to compare prognostic value of Korean and Western nomogram for exercise capacity in Korean patients with cardiovascular disease (CVD). Methods: In this retrospective cohort study, we enrolled 1178 patients (62 ± 11 years; 78 % male) who referred for cardiopulmonary exercise testing in cardiac rehabilitation program. Median follow-up was 1.6 years. Exercise capacity was measured in metabolic equivalents (MET) by direct gas exchange method during the treadmill test. The nomogram for exercise capacity from healthy Korean and previous landmark western study was used to determine the percentage of predicted exercise capacity. The endpoint was the composite of major adverse cardiovascular event (MACE; all-cause death, myocardial infarction, repeat revascularization and stroke) and hospital readmission for heart failure. Results: In multivariable cox proportional hazard analysis, the risk of primary endpoint was more than twice (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.12-4.46) in the patients with lower exercise capacity (<85% of predicted) by Korean nomogram. The lower exercise capacity was the most powerful predictor following age and left ventricular ejection fraction. However, the lower exercise capacity by Western nomogram could not predict the primary endpoint (HR 1.28, 95% CI 0.81-2.04). Conclusion: CVD patients with lower exercise capacity have higher risk of MACE and readmission for heart failure. Considering inter-ethnic differences in cardiorespiratory fitness, Korean nomogram provides more suitable reference values to determine lower exercise capacity to predict cardiovascular events in Korean patients with CVD.
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