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Prognostic capacity and optimal cut-off value of peak oxygen consumption in obese patients with heart failure
Session:
CO5 - Insuficiência Cardíaca
Speaker:
Rita Loreto Ilhão Moreira
Congress:
CPC 2019
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:
Rita Ilhão Moreira; Tiago Pereira Da Silva; António Valentim Gonçalves; Tânia Branco Mano; Vera Ferreira; Tiago Mendonça; Madalena Coutinho Cuz; Pedro Rio; Joana Gomes Feliciano; Rui M. Soares; Rui Cruz Ferreira
Abstract
<p><strong>Background:</strong> The optimal cut-off value of peak oxygen consumption (pVO<sub>2</sub>) for determining prognosis and helping guide timing of heart transplantation in obese patients (pts) with heart failure (HF) and reduce ejection fraction is still debatable. International guidelines suggest that a higher lean body mass–adjusted pVO<sub>2</sub> could serve as an optimal threshold to guide prognosis, however this is weakly supported by evidence (Class IIb, Level of Evidence B).</p> <p><strong>Aim:</strong> We sought to evaluate the accuracy of pVO<sub>2</sub> to guide prognosis in obese pts and define the optimal cut-off value in this population.</p> <p><strong>Methods:</strong> Ambulatory pts with symptomatic HF and left ventricular ejection fraction (LVEF) ≤40%, followed in our center, prospectively underwent a baseline comprehensive evaluation including cardiopulmonary exercise testing (CPET) parameters. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support. All pts were followed-up for 60 months. Pts were divided according to body mass index (BMI ≤30 and >30 kg/m<sup>2</sup>). pVO<sub>2</sub> was normalized for body mass and in obese pts adjusted to lean body mass. Association of pVO<sub>2</sub> and combined endpoint was investigated by ROC curve and an optimal cut-off was calculated by means of the Youden-Index.</p> <p><strong>Results:</strong> In the 282 enrolled pts (75% male, 54±12 years, LVEF 27±7%), 22.7% had BMI >30 kg/m<sup>2</sup>. Obese pts had higher LVEF (28±1% vs. 26±2%, p 0.004) and higher Heart Failure Survival Score (p 0.048). There were no statistically differences regarding CPET parameters. Combined endpoint occurred in 69 pts and higher BMI was associated with better prognosis (HR 0.941, 95% CI 0.886 – 0.998, p 0.043). pVO<sub>2</sub> was an accurate predictor of adverse outcomes in obese and non-obese pts (AUC 0.725, p 0.011 and AUC 0.786, p <0.001, respectively). In non-obese pts, an optimal cut-off was calculated at 14.5 mL/kg/min (sensibility 56%, specificity 94%). In obese pts, an optimal cut-off was calculated at 16.5 mL/kg/min (sensibility 57%, specificity 80%), which was associated with adverse outcomes even after correction for HFSS (HR 3.501, 95% CI 1.169–12.642, p 0.046). In obese pts, Kaplan–Meier analysis revealed an event free survival for subjects with <16.5 and ≥16.5 mL/kg/min of 55.6% and 87.0%, respectively (Fig. 1).</p> <p><strong>Conclusion:</strong> Peak oxygen consumption was an accurate predictor of adverse outcomes in HF obese pts. Higher cut-off values should serve as an optimal threshold to guide prognosis in those pts.</p>
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