Oxygen uptake efficiency slope: A new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise

Objectives. We investigated the usefulness of a new variable, oxygen uptake efficiency slope (OUES), as a submaximal measure of cardiorespiratory functional reserve. The OUES is derived from the relation between oxygen uptake (Vo(2) [ml/min]) and minute ventilation (VE [liters/min]) during incremental exercise and is determined by Vo(2) = a log VE + b, where a = OUES, which shows the effectiveness of Vo(2). Background. Maximal oxygen uptake (Vo(2) max) is effort dependent. There is no standard submaximal measurement of cardiorespiratory reserve that provides generally acceptable results. Methods. Exercise tests, following a standard Bruce protocol, were performed on a treadmill by 108 patients with heart disease and 36 normal volunteers. Expired gas was continuously analyzed. The OUES was calculated from data of the first 75%, 90% and 100% of exercise duration. We also determined the following submaximal variables: the ventilatory anaerobic threshold (VAT), the slope of the regression line of the minute ventilation-carbon dioxide production relation (VE-Vco(2) slope) and the extrapolated maximal oxygen consumption (EMOC). We analyzed the relation of OUES and other submaximal variables against Vo(2) max and examined the effects of submaximal exercise on OUES. Results. The correlation coefficient of the logarithmic curve-fitting model was 0.978 +/- 0.016 (mean +/- SD). The OUES and Vo(2) max had a significant correlation (r = 0.941, p < 0.0001). The correlation between Vo(2) max and OUES was stronger than that between Vo(2) max and VAT, the VE-Vco(2) slope or EMOC. The OUES values for 100% and 90% of exercise were not different from each other (at an alpha value of 0.05 and treatment effect of 170, the power of the test [1 - beta] was 0.90); OUES for 75% of exercise was slightly lower (3.5%). Conclusions. Our results suggest that OUES may provide an objective, effort-independent estimation of cardiorespiratory functional reserve that is related both to pulmonary dead space and to metabolic acidosis.