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Cardiopulmonary Exercise Testing in Female Heart Failure Patients: Is There a Gender Difference?
Session:
Painel 1 -Insuficiencia cardiaca 3
Speaker:
Pedro Brás
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Garcia Brás; António Valentim Gonçalves; João Pedro Reis; Tiago Pereira Da Silva; Rita Ilhão Moreira; Alexandra Castelo; Vera Ferreira; Pedro Rio; Sofia Silva; Carina Martins; Sónia Coito; Eunice Capilé; Rui M. Soares; Rui Cruz Ferreira
Abstract
<p>Introduction: Cardiopulmonary exercise testing (CPET) is often performed to predict major cardiac events in heart failure (HF) patients, however there is no recent evidence regarding the prognostic power of CPET parameters in female HF patients. The International Society for Heart and Lung Transplantation (ISHLT) guidelines recommend that, in female patients, percent of predicted peak VO<sub>2</sub> (pVO<sub>2</sub>) or V<sub>E</sub>/V<sub>CO2</sub> slope be considered in conjunction with peak VO<sub>2</sub> but their prognostic power is unclear in this group of patients.</p> <p>The aim of this study was to compare the prognostic ability of CPET parameters between female and male HF patients.</p> <p>Methods: Retrospective evaluation of patients with CHF submitted to CPET in a tertiary center. Patients were followed up for 36 months for the combined endpoint of cardiac death, urgent heart transplantation or need for mechanical circulatory support. Several CPET parameters were analysed as potential predictors of the combined endpoint and their predictive power was compared (area under the curve (AUC) analysis, Hanley & McNeil test for comparison of AUCs) between two groups: female patients (group A) and male patients (group B).</p> <p>Results: 359 patients were evaluated, mean age 55±13 years, 22% female gender, with a mean New York Heart Association class of 2.18±0.54 and 157 (44%) patients with an ischemic cause for HF.</p> <p>Female patients had a higher mean Heart Failure Survival Score (8.9±0.8 vs 8.6±1.1; p=0.009) and there were no significant differences between groups regarding age (54.35±13.82 vs 55.87±12.17; p=0.346), left ventricular ejection fraction (30±7 vs 29±8; p=0.285) or mean CPET respiratory exchange ratio (RER) (1.06±0.1 vs 1.07±0.1, p=0.722)</p> <p>There were 69 major cardiac events (58 deaths and 11 urgent heart transplantations) during the 3-year period, with no significant difference between groups (14.3% vs 20.6%, p=0.215).</p> <p>pVO<sub>2</sub>, percent of predicted pVO<sub>2</sub>, V<sub>E</sub>/VCO<sub>2</sub> slope and oxygen uptake efficiency slope (OUES) had statistically superior predictive power in female HF patients.</p> <p>The discriminative power of each parameter analysed by gender is presented in Table 1.</p> <p>A pVO<sub>2</sub> value of ≤14 mL/Kg/min had a positive predictive power of 50% in group A and 41% in group B. Group A: Sensitivity of 82% and specificity of 83%, Group B: Sensitivity of 54% and specificity of 84%.</p> <p>A V<sub>E</sub>/V<sub>CO2</sub> slope value of >35 had a positive predictive power of 45% in group A and 37% in group B. Group A: Sensitivity of 90% and specificity of 83%. Group B: Sensitivity of 56% and specificity of 74%.</p> <p>Ventilatory power, heart rate recovery 1 minute after exercise (HRR), end-tidal CO<sub>2</sub> pressure (PETCO<sub>2</sub>) at anaerobic threshold (AT) and maximum exercise (Max) did not show significant difference in prognostic power between groups.</p> <p>Conclusion: pVO<sub>2, </sub>percent of predicted peak VO<sub>2 </sub>and V<sub>E</sub>/V<sub>CO2</sub> slope have a significantly higher predictive power of major cardiac events in female HF patients in comparison to male patients.</p>
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