Background Little is known about exercise cardiac power (ECP), defined as the ratio of directly measured maximal oxygen uptake with peak systolic blood pressure during exercise on heart failure (HF) risk. We examined the association of ECP and the risk of HF.

Methods This was a population-based cohort study of 2351 men from eastern Finland. The average time to follow-up was 25 years. Participants participated at baseline in an exercise stress test. A total of 313 cases of HF occurred.

Results Men with low ECP (<9.84 mL/mmHg, lowest quartile) had a 2.37-fold (95% confidence interval (CI): 1.68 − 3.35, p < 0.0001) hazards ratio of HF as compared with men with high ECP (>13.92 mL/mmHg, highest quartile), after adjusting for age. Low ECP was associated with a 1.96-fold risk (95%CI: 1.38 − 2.78, p < 0.001) of HF after additional adjustment for conventional risk factors. After further adjustment for left ventricular hypertrophy, the results hardly changed (hazards ratio = 1.87, 95%CI: 1.31 − 2.66, p < 0.001). One SD increase in ECP (3.16 mL/mmHg) was associated with a decreased risk of HF by 28% (95%CI: 17% − 37%).

Conclusion ECP provides a non-invasive and easily available measure from cardiopulmonary exercise test in predicting HF. However, ECP did not provide additional value over maximal oxygen uptake.