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Treadmill testing and prognosis: Are we looking at the right things?
Session:
Posters (Sessão 5 - Écran 5) - Exercício e Reabilitação Cardíaca 2
Speaker:
Rafaela G. Lopes
Congress:
CPC 2022
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
28.12 Physical Inactivity and Exercise
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rafaela Gonçalves Lopes; Inês Oliveira; Isabel Cruz; Bruno Bragança; Joel Ponte Monteiro; Alexandra Castro; Conceição Queirós; Paula Pinto; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">Background: </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">Patients with known coronary artery disease (CAD) are frequently re-evaluated with treadmill stress-testing (TT). Typical parameters for decision making are </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">ST-T changes, symptoms, and</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> stress-</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">test positivity</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">. However the long-term prognostic value of such parameters is unclear.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">Purpose: To identify TT parameters associated with all-cause mortality</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">Methods: </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">We performed a retrospective analyze of a</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> cohort of 497 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">consecutive </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">patients with known CAD, who underwent Bruce protocol treadmill testing</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> (TT)</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> between 2009-2010, followed </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">during </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">9.7±2.7years</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">. We analyzed known cardiovascular risk factors and the available parameters of TT, and their correlation with the </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">occurrence of </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">all-cause mortality during the follow-up</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">.</span></span></span> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">Results: </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> During </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">the follow-up period 73 deaths occurred</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">, of these </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">22</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> were</span></span></span> <span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">cardiovascular (</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">CV</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">)</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> deaths</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> (15%). </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> In survival analyses, ST-T changes</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> (p= 0.55)</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">, symptoms</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> (p=0.59)</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">, and test positivity</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> (p=0.618) were not associated with death. Age (68.1</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 10.7 vs 73.9 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 11.4, p<0.01), heart rate (HR) at peak of effort (134.9</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 19.1 vs 123.7 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 23.4, p<0.01), </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">metabolic equivalent of task</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> (MET)</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> (9.1</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 1.8 vs 7.89 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 1.76, p<0.01)</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">, double product at peak </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">(22724.3</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 5049.3 vs 20830 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 5760.6, p= 0.03)</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">, variation of heart rate from peak to rest (</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">63</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 18 vs 51 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 22, p<0.01) and </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">variation of heart rate from rest to recovery (</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">14.9</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">16.3 vs </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">9.4</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> 7.7, </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">p= 0.03) were statistically correlated with all-cause mortality. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">Conclusion: </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">This work</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> shows</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> that the most commonly valued treadmill stress testing parameters might not be relevant prognostic markers in patients with known CAD. On the other hand, the underappreciated simple parameters might predict all-cause mortality </span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black">in</span></span></span><span style="font-size:13.5pt"><span style="font-family:Times"><span style="color:black"> this group of patients.</span></span></span></span></span></p>
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