Comparison of cardiorespiratory fitness in black or african American versus caucasian patients with heart failure

Justin M. Canada, Tae Shik Park, Krishna Ravindra, Juan G. Chiabrando, Marco Giuseppe Del Buono, Jessie van Wezenbeek, Cory R. Trankle, Dinesh Kadariya, Larry Keen, Salvatore Carbone, Hayley Billingsley, George F. Wohlford, Ross Arena, Benjamin W. van Tassell, Antonio Abbate

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Purpose: Cardiopulmonary exercise testing (CPX) is a well-established assessment with important insight into prognosis and therapeutic efficacy in patients with heart failure (HF). Prior studies have identified several clinical differences between Black or African American (B-AA) and Caucasian patients with HF. Differences in key CPX responses between these two groups require further investigation. Methods: Using a database consisting of subjects with symptomatic HF who had undergone CPX for inclusion in various prospective randomized clinical trials, we identified 198 (n = 94 [47%] B-AA; n = 105 [53%] Caucasian) patients with a qualifying baseline CPX. Significant univariate predictors of peak oxygen uptake (Vo2peak) were included in a multivariate linear regression model. Results: When compared with Caucasian patients, B-AA were younger (mean ± SD = 54.8 ± 10.0 vs 57.9 ± 9.6 yr, P =.03), had higher C-reactive protein (CRP) (median [IQR] = 4.9 [2.3, 8.8] vs 1.9 [0.6, 5.5] mg/L, P <.0001), lower hemoglobin (13.0 ± 1.8 vs 13.8 ± 1.6 g/dL, P =.003), and lower left ventricular ejection fraction (LVEF) (40 [32, 51] vs 53 [43, 59]%, P <.00010). During CPX, B-AA patients also had lower Vo2peak (14.6 ± 3.9 vs 17.6 ± 4.8 mL·kg−1·min−1, P <.0001). No differences were observed between B-AA and Caucasian in the minute ventilation/carbon dioxide production (Ve/Vco2) slope (P =.14). The difference in Vo2peak between B-AA and Caucasian was largely attenuated after adjusting for age, body mass index, CRP, N-terminal pro-brain natriuretic peptide, hemoglobin, LVEF, and peak HR (14.1: 95% CI, 13.2-14.9 vs 15.6: 95% CI, 14.4-16.8 mL·kg−1·min−1, P =.053). Conclusions: Directly measured Vo2peak was significantly lower in B-AA than in Caucasians with HF. This is largely explained by differences in clinical characteristics, whereas no significant differences were observed in the Ve/Vco2 slope.

Original languageEnglish
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Publication statusAccepted/In press - 2021


  • Cardiorespiratory fitness
  • Heart failure
  • Peak oxygen uptake
  • Prognosis
  • Race

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