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Workload-indexed blood pressure response predicts cardiovascular events in coronary artery disease
Session:
Comunicações Orais (Sessão 18) - Doença Coronária e Cuidados Intensivos 4 - Risco e Prognóstico
Speaker:
Bruno Bragança
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bruno Bragança; Inês Oliveira; Isabel Cruz; Rafaela Lopes; Conceição Queirós; Paula Pinto; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Abnormal blood arterial pressure response to exercise (BPR) is a cardiovascular (CV) risk factor (CVRF). The concept of pathological BPR, believed to be an excessive raise or decrease, has been challenged. The workload-indexed blood pressure response (WBPR) recently emerged in an attempt to normalize hypertensive responses to exercise. However, it remains to be explored its value in high-risk CV subjects.</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-family:"Arial",sans-serif">Methods: </span></strong><span style="font-family:"Arial",sans-serif">A cohort of 318 patients with known coronary artery disease (CAD), who underwent Bruce protocol treadmill testing between 2009-2010, were retrospectively followed to 11/2021 (9.9±2.3years) to assess the predictive value of WBPR for the occurrence of death and CV events. The WBPR is the ratio between systolic blood pressure variation from rest to peak exercise (?SBP) and metabolic equivalent of task (MET-1). High and low ?SBP/MET groups were created based on median value for this sample (5.2 mmHg/MET). Data presented: mean ± standard deviation; 95% confidence interval (CI) for hazard ratios (HR); significance between groups <em>p</em><0.05. </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-family:"Arial",sans-serif">Results: </span></strong><span style="font-family:"Arial",sans-serif">Low vs high ?SBP/MET groups were similar at baseline for sex (88% male,<em>p</em>=0.67), hypertension (63%,<em>p</em>=0.18), diabetes (32%,<em>p</em>=0.34); dyslipidemia (72%,<em>p</em>=0.62), myocardial infarction (75%,<em>p</em>=0.39) and heart failure (HF) (9.9%,<em>p</em>=0.07), with exception for overweight/obesity (90% vs 82%,<em>p</em>=0.009) and age (57±11 vs 61±8 years, <em>p</em>=0.009) that were higher in the ?SBP/MET<sup>high</sup>. No significant differences were detected between groups for medication at baseline, including anti-hypertensive/-thrombotic/-ischemic drugs. In the follow-up period occurred 43 deaths (12 CV deaths), 58 reinfarctions, 94 worsening/<em>de novo </em>HF and 29 strokes. A non-linear J-shaped relationship was observed between ?SBP/MET and most events. In survival analyses using Cox regression, ?SBP/MET<sup>high</sup> was associated with all death (HR 2.0 (CI 1.0-3.9,<em>p</em>=0.042), reinfarction (HR 2.3 (CI 1.2-4.1,<em>p</em>=0.008), and worsening/<em>de novo </em>HF (HR 1.7 (CI 1.0-2.9,<em>p</em>=0.043) after adjusting for age, CVRFs and medication. In receiver operating characteristic curves, adding ?SBP/MET to a model with other cardiac stress variables (double product, ST-T changes, symptoms, and test positivity) significantly improved the power to predict all death, with an area under curve of 0.73 (CI 0.66-0.80,<em>p</em>=0.037). </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-family:"Arial",sans-serif">Conclusion:</span></strong><span style="font-family:"Arial",sans-serif"> Data shows, for the first time, that ?SBP/MET is a powerful independent predictor of future cardiovascular events and deaths in the high-risk CAD population.</span></span></span></p>
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