SPC365

The role of phase 3 Cardiac Rehabilitation in Boosting Peak VO2 and Predicting Clinical Success

Session: SESSÃO DE POSTERS 01 - CAMINHOS PIONEIROS EM REABILITAÇÃO CARDÍACA - INOVAÇÃO E CUIDADO CENTRADO NO DOENTE
Speaker: Inês Caldeira Araújo

Congress: CPC 2025
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Cartazes
FP Number: ---
Authors: Inês Caldeira Araújo; Ana Abrantes; Miguel Azaredo Raposo; Madalena Lemos Pires; Mariana Borges; Gonçalo Sá; Pedro Alves da Silva; Nelson Cunha; Inês Aguiar-Ricardo; Fausto J. Pinto; Ana Abreu; Rita Pinto

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:&nbsp;</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Recent evidence underscores cardiac rehabilitation (CR) as essential for recovery and functional improvement after cardiovascular events. After completing a phase 2 CR program, patients are encouraged to progress to a phase 3 long-term CR program to optimize their cardiorespiratory fitness. While the cardiopulmonary exercise test (CPET) is a practical tool for evaluating functional gains during CR, its utility in predicting long-term outcomes remains unclear.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:&nbsp;&nbsp;</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To assess the association between improvements in VO2 peak after one year of phase 3 CR and clinical outcomes.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">This prospective observational single-center study included patients enrolled in a phase 3 CR program between 2016 and 2024. Clinical, imaging and CPET data were collected at baseline while CPET data was also collected one year after the program. Clinical outcomes included a composite of all-cause mortality, cardiovascular hospitalizations, and urgent care visits. Patients were categorized into 3 groups based on VO2 peak changes: improvement &ge;5%, stable VO2 peak (&lt;5% change), and decline &gt;5%.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:&nbsp; </strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 284 patients (78% male, 61 &plusmn; 11 years) enrolled in phase 3&nbsp; CR program. The primary indication for referral was ischemic cardiomyopathy (84%). Common comorbidities included diabetes (18%), active smoking (9%), hypertension (50%), dyslipidemia (46%), atrial fibrillation (7%), and prior stroke (5%). Echocardiographic findings included a mean left ventricular ejection fraction (LVEF) of 54 &plusmn; 13% and TAPSE of 21 &plusmn; 5 mm. After one year of phase 3 CR, significant improvements in CPET parameters were observed: VO2 peak (22.6 &plusmn; 6.6 vs. 24.3 &plusmn; 7.4 mL/kg/min, p&lt;0.001), percentage of predicted VO2 peak (98 &plusmn; 19% vs. 105 &plusmn; 21%, p&lt;0.001), and peak PETCO2 (34 &plusmn; 4.4 vs. 35 &plusmn; 4.9 mmHg, p&lt;0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">During a mean follow-up of 3.4 &plusmn; 2.4 years, there were 4 deaths, 13 cardiovascular-related hospitalizations, and 34 urgent cardiovascular visits. The mean time to the first composite event was 2.7 &plusmn; 1.8 years. Patients with VO2 peak improvement after one year of phase III CR demonstrated a trend toward fewer adverse events compared to those with stable or declining VO2 peak values. Additionally, adverse events were similar between the group with a stable VO2 peak and those with a declining VO2 peak, and both were higher compared to those with VO2 peak improvement (25% vs. 32% vs. 33% of composite outcomes in the improvement, stable, and declining groups, respectively)</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:&nbsp;</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Our findings underscore the value of CPET in assessing CR outcomes. Patients showing a &ge;5% improvement in VO2 peak after one year of phase 3&nbsp; CR had better clinical outcomes. Importantly, a stable VO2 peak was associated with adverse event rates similar to those with a declining VO2 peak, highlighting the need for continuous monitoring and management.</span></span></span></p>

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