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Cardiac Rehabilitation in STEMI: an assessment of functional capacity improvement
Session:
Painel 5 - E-Cardiologia e Saúde Publica 1
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2020
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Posters
FP Number:
---
Authors:
Gonçalo Lopes Da Cunha; Bruno M. Rocha; Pedro Lopes; Mónica Neto; Sofia Santos; Marisa Trabulo; Carlos Aguiar; Maria João Andrade; Anai Durazzo; Miguel Mendes
Abstract
<p><strong>Background: </strong>Cardiac rehabilitation (CR) is recommended in all patients with a recent ST-segment elevation MI (STEMI), yet dedicated teams are outnumbered by the burden of ischemic heart disease. The aim of this study was to assess the role of cardiopulmonary exercise testing (CPET) in identifying STEMI patients who may derive a greater functional capacity benefit from CR.</p> <p><strong>Methods: </strong>This is a single-center cohort of consecutive patients with a recent (<90 days) STEMI enrolled in a CR program involving supervised exercise, cardiovascular risk factor modification, self-management education and counselling, from 2016 to 2019. CPET was performed at baseline and repeated at the end of the program, as per site protocol.</p> <p><strong>Results: </strong>A cohort of 105 patients (mean age 52 ± 18 years, 80% male, 67.6% previous or current smokers, 56.2% hypertensive, mean BMI 27.9 ± 4.2 Kg/m<sup>2</sup>) with a mean LVEF of 49 ± 12% was assessed. At enrollment, most were receiving antiplatelet therapy (AAS: 91.4%; and P2Y12 inhibitors: 93.3%), neurohormonal antagonism (ACEi or ARB: 92.4%;), beta-blockers (88.6%) and statins (95.2%). At baseline, mean peak oxygen uptake (pVO<sub>2</sub>) was 24.8 ± 6.1 mL/Kg/min, while predicted pVO<sub>2 </sub>(%ppVO<sub>2</sub>) was 95.7 ± 16.5% and ventilation/carbon dioxide production (VE/VCO<sub>2</sub>) slope was 33.6 ± 6.1. After 2 months of CR, repeated CPET showed a significant gain in mean pVO<sub>2</sub> (+1.3 ± 3.3mL/Kg/min; p<0.001) and %ppVO<sub>2</sub> (+4.3 ± 11.8%; p<0.001) and a decrease in resting heart rate (-2.3 ± 8.9bpm; p=0.003). In multivariate analysis, baseline %ppVO<sub>2 </sub>was the sole predictor of 2-month pVO<sub>2</sub> gain (p=0.020). However, the observed negative correlation between pVO<sub>2</sub> gain and %ppVO<sub>2 </sub>was weak (r = -0.262; p=0.005). ROC curve analysis confirmed that baseline % ppVO<sub>2</sub> has poor predictive value to identify patients who derive larger gains in pVO<sub>2</sub> at 2-month.</p> <p><strong>Conclusions: </strong>A comprehensive CR program enrolling patients with a recent STEMI led to a significant improvement in pVO<sub>2</sub> and %ppVO<sub>2</sub>. Whilst %ppVO2 at baseline CPET independently predicted pVO<sub>2</sub> gain after 2-month CR, the correlation was rather weak, suggesting that CPET should not be used to select STEMI patients who may derive a greater benefit from CR.</p>
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