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07. Syncope and Bradycardia
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Prognostic value of ventilation equivalent of carbon dioxide slope in overweight heart failure patients
Session:
CO 07 - IC -Prognóstico
Speaker:
António Valentim Gonçalves
Congress:
CPC 2018
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
António Valentim Gonçalves; Rui M. Soares; Tiago Pereira Da Silva; Joana Gomes Feliciano; Rita Ilhão Moreira; Pedro Rio; Ana Abreu; Sílvia Aguiar Rosa; Madalena Coutinho Cruz; Tiago Mendonça; Luís Almeida Morais; Pedro Modas; Dra. Inês Rodrigues; Tânia Branco Mano; João Pedro Reis; Rui Cruz Ferreira
Abstract
<p><strong>Aims: </strong>Recent studies have shown that the ventilation equivalent of carbon dioxide (V<sub>E</sub>/V<sub>CO2</sub>) slope is at least as good as peak oxygen consumption (pVO<sub>2</sub>) for predicting major cardiac events in heart failure (HF) patients.</p> <p>Pulmonary function and ventilation mechanics are not normal in overweight patients, leading to increased potential for obesity-hypoventilation syndrome and decreased hypercapnic ventilatory responses which would appear to lower the V<sub>E</sub>/V<sub>CO2</sub> but worsen prognosis. The aim of this study was to compare the prognostic ability of the V<sub>E</sub>/V<sub>CO2</sub> slope and pVO<sub>2 </sub>between normal and overweight HF patients.</p> <p><strong>Methods</strong><strong>:</strong> Ambulatory patients followed in our institution in NYHA class II-III with left ventricular ejection fraction ≤40%, underwent a prospective evaluation including a CPET. All patients were followed for 60 months and the combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support.</p> <p>The V<sub>E</sub>/V<sub>CO2</sub> slope and pVO<sub>2 </sub>were analysed as potential predictor of the combined endpoint in 12, 36 and 60 months (Cox regression) and their predictive power was compared (area under the curve (AUC) analysis, Hanley & McNeil test for comparison of AUCs), in the subgroups of patients with body mass index (BMI) of 18.5-24.9 kg/m<sup>2</sup> (group A) and ≥25 kg/m<sup>2</sup> (group B).</p> <p><strong>Results:</strong> In the 274 enrolled patients 4 were excluded from analysis since had a BMI <18.5 kg/m<sup>2</sup>. Mean BMI was 26.93±4.21 kg/m<sup>2</sup>, with 205 males (75.9%), mean New York Heart Association class of 2.21±0.46 and 103 (38.1%) patients with an ischemic cause for HF. Group B were older (50.55±14.28 vs 55.23±10.42; p=0.006), but with higher left ventricular ejection fraction (25.55±6.93 vs 28.28±7.41; p=0.004) and higher Heart Failure Survival Score (8.43±0.57 vs 8.78±0.94; p=0.004).</p> <p>There were 88 major cardiac events (70 deaths and 18 urgent heart transplantations) during the 5-year period, with no significant difference between group A and B (38.0% vs 29.8%, respectively; p=0.170). The discriminative power of V<sub>E</sub>/V<sub>CO2</sub> slope, pVO<sub>2 </sub>and their comparison in 12, 36 and 60 months in group A and B are presented in the Table.</p> <p>The V<sub>E</sub>/V<sub>CO2</sub> slope had at least as good AUC values as pVO<sub>2</sub> in both A and B groups irrespective of the follow-up time. At 36 months in group A, V<sub>E</sub>/V<sub>CO2</sub> slope nearly approach better predictive power than pVO<sub>2 </sub>(p=0.072).</p> <p>The comparison of V<sub>E</sub>/V<sub>CO2</sub> slope between group A and B revealed a significant lower predictive power with V<sub>E</sub>/V<sub>CO2</sub> slope at 36 and 60 months for overweight patients (p=0.022 and p=0.044, respectively).</p> <p><strong>Conclusion:</strong> Despite V<sub>E</sub>/V<sub>CO2</sub> slope provides a discriminative power at least as good as pVO<sub>2</sub> for predicting adverse events in both normal and overweight HF patients, a significant lower predictive power was found in overweight patients in long-term outcomes.</p>
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