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Discordance Between Measured vs Calculated Oxygen Consumption in Adults With Congenital Heart Disease: Limitations
Pradyumna Agasthi1, William R Miranda, Alexander C Egbe
1Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054 USA. pradyumna_agasthi@hotmail.com.
Insights
Estimated oxygen consumption (VO2) formulas lead to significant errors in adults with congenital heart disease (CHD). Measured VO2 is more accurate for assessing invasive hemodynamics in CHD patients.
Area of Science:
- Cardiology
- Physiology
- Medical Diagnostics
Background:
- Oxygen consumption (VO2) is often estimated using formulas for convenience in clinical practice.
- Adults with congenital heart disease (CHD) may have altered physiology affecting VO2 estimation accuracy.
Purpose of the Study:
- To evaluate the correlation and agreement between measured VO2 and VO2 estimated by common formulas in adults with CHD.
- To determine the clinical implications of using estimated VO2 in assessing hemodynamics in this population.
Main Methods:
- Prospective study enrolling 84 adults with CHD undergoing cardiac catheterization.
- Measured VO2 via expired gas analysis and estimated VO2 using LaFarge, Dehmer, and Bergstra formulas.
- Statistical analysis included linear regression and Bland-Altman analysis.
Main Results:
- Dehmer formula showed good correlation (r=0.79) with measured VO2, while LaFarge and Bergstra showed moderate correlation (r=0.58, r=0.44).
- All formulas exhibited wide limits of agreement, indicating poor precision in estimating VO2.
- Estimated VO2 led to misclassification of cardiac index in a significant proportion of patients.
Conclusions:
- Assumed VO2 values derived from formulas introduce substantial errors in the assessment of invasive intracardiac hemodynamics in adults with CHD.
- Clinical decisions based on estimated VO2 may be inaccurate, highlighting the need for measured VO2 in this patient group.
Introduction:
Oxygen consumption (VO2) is frequently estimated using derived formulas for ease of use. We performed a prospective study to assess the correlation and limits of agreement between measured and assumed VO2 (mL/min) in adults with congenital heart disease (CHD).
Methods:
Consecutive adults with CHD who have undergone cardiac catheterization at Mayo Clinic Rochester from January 2018 to December 2019 were retrospectively enrolled in the study. Expired gas analysis was performed to measure VO2. We estimated VO2 using LaFarge (VO2L), Dehmer (VO2D), and Bergstra (VO2B) formulas. Bland-Altman and linear-regression analyses were used to assess the correlation between measured and calculated VO2.
Results:
We enrolled 84 patients with a mean age of 43 ± 12 years; 66% were men. Linear correlation analysis showed a moderate correlation of VO2L and VO2B with VO2M (r = 0.58; P<.001 and r = 0.44; P<.01, respectively) and good correlation of VO2D with VO2M (r = 0.79; P<.001). The large spread of limits of agreement assessed using Bland-Altman analysis demonstrates poor agreement of VO2L and VO2B with VO2M (bias, -58; 95% confidence interval [CI], -258 to 48) and bias, 38; 95% CI, -91 to 167, respectively). The limits of agreement for VO2D have a large spread, demonstrating a low degree of agreement with VO2M (bias, 13; 95% CI, -64 to 89). VO2L predominantly misclassified patients as low cardiac index and VO2D and VO2B misclassified patients as normal/ high cardiac index.
Conclusion:
In adults with CHD, assumed VO2 will lead to a significant error while assessing invasive intracardiac hemodynamics.
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