Cardiorespiratory Fitness Reference Standards and Prognostic Stratification in Chinese Patients With Cardiovascular Disease
Related Experiment Video
Updated: Jun 28, 2026
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Haoning Cui1, Xiaojun Wu1, Xiang Xie2
1Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Cardiac Rehabilitation Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Insights
This study establishes cardiorespiratory fitness (CRF) reference standards for Chinese patients with cardiovascular disease (CVD), improving risk stratification for major adverse cardiovascular events (MACE). The new standards show lower CRF in CVD patients compared to healthy adults, aiding personalized care.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Exercise Physiology
Background:
- Cardiorespiratory fitness (CRF) is crucial for risk stratification in cardiovascular disease (CVD).
- Current CRF assessment in Chinese CVD patients uses non-specific standards, risking misclassification.
- Establishing tailored reference standards is vital for accurate risk assessment.
Purpose of the Study:
- To develop specific CRF reference standards for Chinese patients with CVD.
- To evaluate the utility of these standards in stratifying major adverse cardiovascular event (MACE) risk.
Main Methods:
- A multicenter retrospective study of 56,495 Chinese CVD patients (2018-2024).
- Derived sex- and age-specific CRF percentiles, comparing them to healthy adults.
- Validated prognostic performance for MACE using Kaplan-Meier and Cox regression in 6,317 patients.
Main Results:
- Established CRF reference standards showed significant differences across sex, age, and CVD subtype.
- Chinese CVD patients exhibited lower peak oxygen uptake (73.3%-84.0% of healthy levels).
- Lower CRF significantly correlated with increased MACE risk (HR 1.46-2.29) and reduced event-free survival.
Conclusions:
- The study presents the first CRF reference standards for Chinese CVD patients.
- These standards effectively stratify MACE risk, enhancing prognostic accuracy.
- Findings support data-driven functional risk assessment and personalized secondary prevention strategies.
Background:
Cardiorespiratory fitness (CRF) is a key metric for risk stratification and clinical decision-making in cardiovascular disease (CVD). CRF assessment in Chinese patients with CVD currently relies on reference standards derived from other patients, which may lead to prognostic risk misclassification.
Objectives:
This study aimed to establish CRF reference standards for Chinese patients and assess their utility in stratifying major adverse cardiovascular event (MACE).
Methods:
We conducted a multicenter retrospective study including 56,495 patients with CVD from 20 hospitals across China from 2018 to 2024. Sex- and age-specific CRF reference values and percentiles were derived using 10-year age groups and compared with those of healthy Chinese adults. Prognostic performance was evaluated in a validation cohort of 6,317 patients (median follow-up: 24 months [IQR: 12-36]) using Kaplan-Meier and Cox regression analyses.
Results:
The established CRF reference standards demonstrated significant differences across sex, age, and CVD subtype (P < 0.001). Compared with age- and sex-matched healthy adults, patients with CVD had lower peak oxygen uptake, with relative CRF levels of 73.3% to 78.7% in men and 75.4% to 84.0% in women. Compared with the high-CRF group, the adjusted MACE risk was higher in the middle-CRF (HR: 1.46; 95% CI: 1.16-1.83; P < 0.001) and low-CRF groups (HR: 2.29; 95% CI: 1.81-2.90; P < 0.001). Kaplan-Meier analysis revealed significantly lower event-free survival with decreasing CRF (log-rank P < 0.001).
Conclusions:
This study establishes the first CRF reference standards specific to Chinese patients with CVD and demonstrates their prognostic utility for MACE risk stratification. These findings provide a data-driven framework for functional risk assessment, secondary prevention, and individualized rehabilitation strategies in clinical practice.
Related Concept Videos
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:20Chronic Obstructive Pulmonary Disease-I: Introduction