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Predictive ability of cardiopulmonary exercise test parameters in Heart Failure patients with Cardiac Resynchronization Therapy
Session:
CO 12 - Cardiologia preventiva/reabilitação
Speaker:
João Pedro Dias Ferreira Reis
Congress:
CPC 2021
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:
João Pedro Reis; António Gonçalves; Pedro Brás; Rita Moreira; Pedro Rio; Tiago Pereira da Silva; Ana Teresa Timóteo; Rui Soares; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""><span style="color:black">Introduction: </span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">There is evidence suggesting that a<span style="color:black"> peak oxygen uptake (</span>pVO<sub>2</sub>) cut-off of 10ml/kg/min provides a more precise risk stratification in Cardiac Resynchronization Therapy<span style="color:black"> (</span>CRT) patients. Our aim was to compare <span style="color:black">the prognostic power of several cardiopulmonary exercise testing (CPET) parameters in </span>patients<span style="color:black"> with CRT and assess the discriminative ability of the guideline-recommended </span>pVO<sub>2</sub><span style="color:black"> cut-off values.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Methods: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Prospective evaluation of consecutive heart failure (HF) patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death and urgent heart transplantation (HT) in the first 24 follow-up months and was analyzed by several CPET parameters for the highest area under the curve (AUC) in the CRT group. A survival analysis was performed to evaluate the risk stratification provided by several different cut-offs.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Results: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">A total of 450 HF patients, of which</span></span><strong> </strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">114 had a CRT device. These patients had a higher baseline risk profile, but there was no difference regarding the primary outcome (13.2% vs 11.6%, p = 0.660).</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> End-tidal carbon dioxide pressure<sub> </sub>at the anaerobic threshold (P<sub>ET</sub>CO<sub>2AT</sub>) had the highest AUC value, which was significantly higher than that of pVO<sub>2</sub> in the CRT group (0.951 vs 0.778, <em>p</em> = 0.046). The currently recommended pVO<sub>2 </sub>cut-off provided accurate risk stratification in this setting (<em>p</em> < 0.001), and the suggested cut-off value of 10 ml/min/kg did not improve risk discrimination in device patients (p = 0.772).</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> P<sub>ET</sub>CO<sub>2AT</sub> outperforms pVO<sub>2</sub>’s prognostic power for adverse events in CRT patients. </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">The current </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""><span style="color:black">guideline-recommended</span></span></span> <span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif"">pVO<sub>2</sub></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""> cut-off can precisely risk-stratify this population.</span></span></span></span></p>
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