SPC365

Prognostic power of peak oxygen pulse in a population undergoing cardiac rehabilitation

Session: Posters - J. Preventive Cardiology
Speaker: Ana Rita 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: Ana Rita Teixeira ; João Ferreira Reis; Alexandra Castelo; Pedro Rio; Sofia Silva; Sofia Jacinto; Bárbara Teixeira; Rui Cruz Ferreira
<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:&quot;Times New Roman&quot;,serif"><span style="color:black">Introduction</span></span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">The peak O2 pulse (OP) provides an estimate of left ventricular (LV) stroke-volume changes during exercise. It has proven to be an independent predictor of mortality in patients with heart disease <span style="background-color:white"><span style="color:black">and a predictor of myocardial ischemia. </span></span></span></span></span></span></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:&quot;Times New Roman&quot;,serif"><span style="color:black">Purpose</span></span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">To characterize the population of the cardiac rehabilitation (CR) appointment that performed cardiopulmonary exercise test (CEPT), evaluate OP as a predictor of events and determine the best cut off for our population.</span></span></span></span></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:&quot;Times New Roman&quot;,serif"><span style="color:black">Methods</span></span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Retrospective analysis of CR appointment 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 then determined predictors of OP and established the appropriate Cut Off for our population and compared the occurrence of events - composite endpoints of mortality/ hospitalization due to heart failure (MH), mortality/ hospitalization due to cardiovascular cause(MC) and &nbsp;mortality/ hospitalization due to heart failure/ need for revascularization (MHR)- according to it.</span></span></span></span></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:&quot;Times New Roman&quot;,serif"><span style="color:black">Results</span></span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><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. 96.6% of P had a cardiovascular disease or risk factors and 99% were medicated, with 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. 6.9% P died from any cause, 33.8% had an hospitalization (78.6% from a cardiovascular reason) and 7.3% presented MH. Mean OP &nbsp;was 13.3&plusmn;4.4mL/beat. A lower OP was associated with an older age (CC=0.399, p&lt;0.001), female sex (p&lt;0.001), diabetes (p=0.007), previous arrhythmias (p=0.015), chronic kidney disease (p=0.018), peripheral artery disease (p=0.040), a lower basal LVEF (CC.0325, p&lt;0.001). It also correlated with a lower peakVO<sub>2</sub> (CC=0.732, p&lt;0.001), a lower cardiorespiratory optimal point (CC=0.514, p&lt;0.001), a lower circulatory power (CC=0.502, &lt;0.001) and a higher VE/VCO<sub>2</sub> slope (CC=0.358, p=0.001). Values of OP below a cut-off of 11.5 predict the composite endpoint of MH (HR 7.31, IC [2.01-26.62], p=0.003), MC (HR 2.03, IC [1.21-3.38], p=0.007) and MHR (HR 1.97, IC [1.04-3.74], p=0.039). Ps with OP values below present a 40 months survival of 76.2% comparing to 97.3% if the peak OP is above the aforementioned cut-off (log-rank p&lt;0.001). CR lead to a statistically significant improvement in peak OP (from 14.2 to 23.5 mL/ beat, p&lt;0.001), however it wasn&#39;t associated to a lower rate of coronary events or revascularization.</span></span></span></span></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:&quot;Times New Roman&quot;,serif"><span style="color:black">Conclusion</span></span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">In our analysis, peak OP was improved after completion of CR program and a value below 11.5 mL/ beat was a predictor of cardiac events in our population</span></span></span></span></p>