SPC365

Identification of diastolic dysfunction on cardiopulmonary exercise testing and its prognostic value

Session: Posters - J. Preventive Cardiology
Speaker: Sofia Jacinto

Congress: CPC 2021
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Posters
FP Number: ---
Authors: Sofia Jacinto; João Reis; Alexandra Castelo; Pedro Rio; Sofia Silva; Bárbara Teixeira; Rita Teixeira; Rui Cruz Ferreira
<p style="text-align:start"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Introduction</span></span></span></strong></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Diastolic dysfunction (DD) is an important pathophysiological mechanism underlying heart failure (HF) with both reduced and preserved ejection fraction. Cardiopulmonary exercise testing (CPET) variables have been extensively studied in systolic dysfunction, but its role in evaluating DD remains to be determined. </span></span></span></p>

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<p style="text-align:start"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Purpose</span></span></span></strong></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To determine predictive factors of the DD and evaluate its prognostic effect in the population of the cardiac rehabilitation (CR) appointment who performed CPET.</span></span></span></p>

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<p style="text-align:start"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Methods</span></span></span></strong></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective analysis of CR appointment patients (P) who underwent CEPT between 2014 and 2017 in a single tertiary center. Epidemiological, clinical, laboratory, echo and CEPT-related data were retrieved. We determined predictors of DD (defined as an E/e&#39; ratio&gt;14)&nbsp; and evaluated its prognostic impact regarding mortality (M), cardiovascular mortality (CV) and mortality/ HF hospitalization (MH). </span></span></span></p>

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<p style="text-align:start"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Results</span></span></span></strong></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">207 P (83.6% men) were included, with a mean age of 57 years and a mean follow-up time of 36 months. Ps presented a mean LVEF of 53.7% (14-83%) and a mean E/e&#39; ratio of 10.1. The majority (87.9%) was referred for CR with ischemic cardiopathy (AMI or stable or unstable coronary disease), 9.2% with heart failure and 9.2% with valvulopathy. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason) and 7.3% presented MH. Comparing Ps with DD to Ps without, similar clinical characteristics were found, although the former were older (p=0.001) and presented both lower basal LVEF (p&lt;0.001) and peak VO2 (p&lt;0.001). There was a statistically significant difference between a higher value of E/e&#39; ratio and higher age (<em>r</em>=0.303, p&lt;0.001), diabetes (p=0.021), chronic kidney disease (p=0.013),&nbsp;left ventricular ejection fraction &lt;35% (p&lt;0.001), higher BNP (<em>r</em> = 0.489, p &lt;0.001), a lower peak VO<sub>2</sub> (<em>r</em> =0.507, p&lt;0.001), a higher cardiorespiratory optimal point (<em>r</em> =0.338, p&lt;0.001) and a lower circulatory power (<em>r</em> =0.325, p&lt;0.001). Of these, independent predictors of higher E/e&#39; ratio were a lower peak VO<sub>2&nbsp;</sub>(p=0.012) and a LVEF &lt;35% (p&lt;0.001). The presence of DD (E/e&#39; ratio&gt;14) was a predictor of M (HR=8.24, IC [1.38-47.4], p=0.021), CV (HR=16.36, IC [1.69-157.57], p=0.016) and MH (HR=7.93, IC [2.23-28.19], p=0.001). Ps with DD presented a lower 30 months survival than Ps with an E/e&#39; ratio &lt;14 (86.3%vs100%, log rank p=0.006).</span></span></span></p>

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<p style="text-align:start"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Conclusion</span></span></span></strong></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">An E/e&#39; ratio &gt;14 was associated with&nbsp;a higher rate of events in our population. Both peak VO<sub>2</sub> and a LVEF &lt;35% are independent factors for the presence of DD.</span></span></span></p>