JACC. Asia · 2026
Cardiorespiratory Fitness Reference Standards and Prognostic Stratification in Chinese Patients With Cardiovascular Disease.
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Cui Haoning, Wu Xiaojun, Xie Xiang, Li Zhongyan, Ma Huan, Shi Hongyan, Zhu Liyue, Zhong Lin, Jiang Wei, Xue Jiahong, Yang Na, Tan Hu, Bai Fangfang, Zheng Yang, Wang Shiyu, Zheng Xianghui, Hou Xinyu, Cao Tianhui, Li Qifeng, Yu Bo, Wu Jian
Аннотация
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.
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.