SPC365

The impact of chronotropic incompetence markers in a population undergoing cardiac rehabilitation

Session: Posters - J. Preventive Cardiology
Speaker: Bárbara Lacerda Teixeira

Congress: CPC 2021
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Posters
FP Number: ---
Authors: Bárbara Lacerda Teixeira; João Reis; Alexandra Castelo; Pedro Rio; Sofia Silva; Rita Teixeira; Sofia Jacinto; Rui Cruz Ferreira
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">During Cardiopulmonary exercise testing (CEPT), a low heart rate recovery at one minute (HRR1) and a low heart rate reserve (HRr) have been assumed to be index of autonomic imbalance and chronotropic incompetence, which are associated with a poor prognosis in several forms of heart disease. Several studies and the AHA/EACPR CPET guidelines showed a correlation between a low HRR1 and a worse outcome in several forms of heart disease.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Purpose</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">To characterize the population of the cardiac rehabilitation (CR) appointment that performed CEPT and to evaluate basal HRR1 and HRr as predictors of events. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Retrospective analysis of CR patients (P) who performed CEPT between 2014 and 2017 in a single tertiary center. Epidemiological, clinical, laboratory, echo and CEPT-related data were retrieved. We evaluated which variables were associated to a low HRR1/ HRr and compared the composite endpoint of mortality/ hospitalization due to heart failure (MH) according to HRR1&lt;16 and HRr&lt;62 beats (both calculated cut-offs for our population). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">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%). 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. Mean HRR1 was 23.7 beats and mean HRr was 61.8 beats. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason) and 7.3% presented MH. &nbsp;A HRR&lt;16 was associated with an older age (61.2vs55.8, p=0.017), diabetes (41.2%vs23.3%, p=0.014), chronic kidney disease (61.5%vs32.4%, p=0.042), previous myocardial infarction (40.0%vs24.1%, p=0.043) and LVEF&lt;35% (18.5%vs4.9%, p=0.008). It also correlated with a higher LDL value pre-CR (170vs111, p=0.034), with a peak VO<sub>2</sub>&lt;14ml/min/kg (58.1%vs22.5%, p&lt;0.001) and lower circulatory and ventilatory power (2967.5vs3992.2, p=0.001 and 4.9vs5.9, p=0.019, respectively). Values of HRR&lt;16 were good predictors of MH (HR=3.38, IC [1.14-10.07], p=0.029). However, HRR&lt;16 did not correlate with all cause hospitalization or need for cardiac device. A value of HRr&lt;62 was associated to an age&gt;65 years (49.9vs65.2, p&lt;0.001), a LVEF&lt;35% (63.2%vs42.7%, p=0.009), a higher VE/VCO<sub>2 </sub>slope (CC=0.289, p&lt;0.001) and a higher cardiorespiratory optimal point (<em>r</em>=0.395, p&lt;0.001). Values of HRr&lt;62 were good predictors of MH (HR=7.31, IC [1.62-33.07], p=0.010 and AUC=0.703).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Ps with HRR1 &lt; 16 or HR &lt; 62 presented a worse prognosis regarding the composite endpoint of MH. Both are easily obtained auxiliary parameters that reflect altered autonomic tone.</span></span></span></span></span></p>