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European Heart Journal 1994 15(2):236-241;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Can anaerobic threshold be used as an end-point for therapeutic trials in heart failure?

Lessons from a multicentre randomized placebo-controlled trial

A. COHEN-SOLAL, J. F. AUPETIT, P. GUERET, H. KOLSKY and F ZANNAD ON BEHALF OF THE Vo2 FRENCH STUDY GROUP

Received 1 April 1993; revised 19 July 1993; .

Coresspondence: Akin Cohem-Solal, MD, Service de Cardiologie, Hôpital Beaujon, 100 Boulevard du General Leclerc, 92110 Clichy Cedex, France

Abstract

‘Anaerobic threshold’ (AT), proposed as a non-invasive index of exercise tolerance, independent of patient motivation, is considered more reliable than exercise duration in assessing the effect of drug therapy in chronic heart failure (CHF). However, inter-observer variation in patients may be more difficult than in normal subjects. In a multicentre study, 85 patients from 10 centres performed a total of 331 bicycle maximal tests (ramp protocols, 10 watts. min–1) with respiratory gas analysis by different systems. A central committee reviewed all the tests. Percentages of AT determination ranged from 34% to 71% depending on the method used. Apart from the respiratory exchange ratio (RER=1) method, which yielded the lowest rate of determination. and the crossing point (when RER=1), which yielded the highest rate, 71%, other methods of determination, such as carbon dioxide (42%), minute ventilation (52%) or ventilatory equivalents plotted vs time (57%), did not dtffer in the rate of AT determination.

Thus, even among trained physicians, AT determination was not reliable. The crossing point may nevertheless be a valuable index from a pragmatic standpoint, although it occurs after the actual AT Peak oxygen uptake should remain the main end-point in assessment of exercise capacity.

Key Words: Anaerobic threshold • exercise test • heart failure


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