SPC365

Improvement in Cardiopulmonary Exercise Test Parameters Phase 2 Rehabilitation and its impact on clinical outcomes

Session: SESSÃO DE POSTERS 01 - CAMINHOS PIONEIROS EM REABILITAÇÃO CARDÍACA - INOVAÇÃO E CUIDADO CENTRADO NO DOENTE
Speaker: Marta Vilela

Congress: CPC 2025
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Cartazes
FP Number: ---
Authors: Marta Miguez Vilela; Ana Abrantes; João Cravo; Alda Jordão; Edite Caldeira; Gisela Afonso; Pedro Alves Silva; Nelson Cunha; Inês Aguiar-Ricardo; Fausto Pinto; Ana Abreu

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction:&nbsp;</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:black">Phase II cardiac rehabilitation (CR) </span>programs have <span style="color:black">shown to enhance functional capacity and clinical outcomes. Cardiopulmonary exercise testing (CPET) is a valuable tool for assessing exercise tolerance and cardiovascular function. However, given the wide range of parameters included in CPET, there&nbsp;is still debate on which specific measures are most reliable for monitoring patient progress during CR.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Purpose:&nbsp;&nbsp;</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:black">To assess CPET parameters as predictors of adverse events in patients after completing CR.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods: </span></strong>&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:black">Prospective observational single-center study including patients enrolled in a phase II CR program between 2016 and 2024. The program involved assessments by cardiologists, nutritionists and psychologists, with </span>exercise<span style="color:black"> sessions twice a week. A composite outcome of all-cause mortality, cardiovascular hospitalizations and urgent visits was evaluated.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:black">A total of 550 patients (80% male, 63&plusmn;11 years) completed a phase II CR program. The majority had ischemic cardiomyopathy (83%). Among those with coronary artery disease, 49% had multivessel disease and 29% incomplete revascularization. During the CR program, we observed a statistically significant improvements in several CPET parameters: exercise time (7 minutes and 46 seconds &plusmn; 9 seconds to 8 minutes and 25 seconds &plusmn; 9 seconds), VO2 peak (15.6 &plusmn; 0.3 to 17 &plusmn; 0.3 ml/kg/min, p&lt;0.01), % of predicted VO2 peak (62.2 % &plusmn; 1.1 to 68.0 % &plusmn; 1,1 p&lt;0.01), PETCO2 (33.6 &plusmn; 0.3 to 34.4 &plusmn; 0.3 p&lt;0.01), circulatory power (2661 &plusmn; 72.1 to 2896 &plusmn; 79 p&lt;0.01), VE/VCO2 slope (32.2 &plusmn; 0.5 to 30.7 &plusmn; 0.4 p&lt;0.01), workload (100.2W &plusmn; 2.7 to 116W &plusmn; 3.1 p&lt;0.01) and peak VO2 at the first threshold (10.7 &plusmn; 0.2 to 11.3 &plusmn; 0.2 ml/kg/min p&lt;0.01). </span></span>&nbsp;<span style="font-family:Calibri,sans-serif"><span style="color:black">During a mean follow-up of 2.97&plusmn; 1.69 years, we registered a total of 21 deaths, 13 of which from cardiovascular causes, alongside 44 admissions for CV causes. The average time to the composite outcome was 1.94 &plusmn; 1.23 years. We noted a trend toward a reduced incidence of adverse outcomes in patients that displayed a global improvement in the aforementioned CPET parameters. Of note, an improvement in circulatory power was positively associated with a reduction in the composite outcome of adverse CV events (p&lt;0,01). Additionally, a statistically significant association was observed between adverse outcomes and a peak VO2 &le; 15 ml/kg/min (p = 0.02) as well as circulatory power &le; 1600 (p = 0.018) at the end of the program. A trend toward worse outcomes was also noted for a VE/VCO2 slope &gt; 33 (p = 0.18) and OUES &le; 1.4 (p = 0.2) in the post-CR CPET. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion</span></strong><span style="color:black">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Calibri,sans-serif"><span style="color:black">Identifying high-risk individuals and referring them to phase III rehabilitation is crucial, with CPET parameters proving valuable for risk assessment. </span>Individuals at high CV risk at the end of CR programs can be identified through routinary CPET assessment, warrating a closer clinical follow-up by prolonging the phase II program or by swiftly incorporation in a phase III program</span></span></p>