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Curso de Atualização em Medicina Cardiovascular 2019
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Cardiopulmonary exercise testing in congenital heart disease: comparing the cyanotic and non cyanotic adults
Session:
Posters 1 - Écran 5 - Congénitos
Speaker:
Tânia Branco Mano
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.2 Congenital Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Tânia Branco Mano; António Valentim Gonçalves; Sílvia Aguiar Rosa; Ana Figueiredo Agapito; Lidia De Sousa; José Alberto Oliveira; André Viveiros Monteiro; Sofia Silva; Sandra Alves; Maria De Fátima Pinto; José Fragata; Rui Cruz Ferreira
Abstract
<p>Background: Cardiopulmonary exercise testing (CPET) has emerged as an important tool for risk stratification, assessing prognosis and planning interventions. However, it remains uncertain how to best apply each parameter in clinical practice, namely in Adult Congenital Heart Disease (ACHD).</p> <p>The aim was to compare functional capacity in Cyanotic (C) and Non-Cyanotic (NC) ACHD patients and to investigate an association between CPET parameters and outcome.</p> <p>Methods: Retrospective analysis of consecutive ACHD who underwent CPET in a tertiary centre, followed up for at least one year. Primary endpoint: death from any cause. Combined secondary endpoint: death from any cause and cardiac hospitalization. CPET parameters were evaluated and determined endpoints predictors in each group.</p> <p>Results: 286 patients were enrolled (50.3% males, mean age of 35.6 ± 9.4 years). 21% (N=60) were cyanotic. There were significant differences in CPET parameters between the study groups: C-ACHD subgroup had lower values for peak oxygen consumption (pVO2) (17.3±4.7ml/kg/min vs 24.2±6.4 ml/kg/min;p< 0.001), rest End-Tidal Carbon Dioxide (ETCO2) (30.6 ±9.4 mmHg vs 49.1±110.5mmHg;p=0,014), Heart rate reserve at 1st minute (HHR1) (19.4±14 vs 27±15,1; p<0,001), chronotropic index (55,3±21,9 vs74,9±21; p<0,001) and higher minute ventilation (VE)/carbon dioxide production (VCO2) slope (48.7±20.4 vs 31.6 ±10;p< 0.001) and optimal point of ventilation (VE/VO2) (34.8±9.3 vs 24.1±6.4; p<0.001). During a mean follow up of 3.89 ± 2.3 years, the primary endpoint was achieved in 8.5% and 1.8% (p=0.021) and the secondary endpoint in 49.1% and 22.9% (p<0.0001) in C-ACHD and NC-ACHD, respectively. The survival curves for primary and secondary endpoints are represented in Graphic 1. The mean survival rate for primary endpoint were 8.5±0.3 years vs. 9.2±0.01 years (log rank 0.028) and for secundary endpoint were 5.2 ±0.5 years vs. 6.8±0.3 years (log rank 0.010), in C-ACHD and NC-ACHD, respectively. Regarding the secondary endpoint, in the C-ACHD subgroup, we found an association with male gender (OR 3.5, p=0.015) and previous palliative surgery was a predictor in univariate analysis (OR 3.487,CI95%:1.354-8.980, p=0.010;). In NC-ACHD patients, age (HR 1.039,CI95%:1.011-1.067, p=0.004), male gender (OR 2.262, 95%CI 1.229–4.166,p=0.009;) and pVO2 (HR0.053,CI95%:0.914-0.945, p=0.028,) were predictors of secondary endpoint in univariate analysis.</p> <p>Conclusion: The C-ACHD population had greater impairment in CPET parameters and worse prognosis with higher mortality and cardiac hospitalizations. However, only in NC-ACHD the CPET parameters were predictors of outcomes.</p>
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