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The prognostic impact of loop gain in heart falilure
Session:
Comunicações Orais - Sessão 01 - Insuficiência Cardíaca: a clínica primeiro
Speaker:
Rita Amador
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Amador; Sérgio Maltês; Bruno Rocha; Duarte Nina; Carlos M. Aguiar; Maria J. Andrade; Luís Moreno; Anaí Durazzo; Miguel Mendes; Gonçalo Cunha; Piergiuseppe Agostoni
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Exercise oscillatory ventilation (EOV) is a strong prognostic marker in patients with heart failure (HF) and left ventricular (LV) dysfunction. However, this parameter has had multiple definitions and a high interobserver variability. This phenomenon can be explained through a single quantitative measurement of ventilatory instability, the loop gain. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We aimed to compare loop gain measurement with exercise oscillatory ventilation (EOV) regarding demographic characteristics and prognostic value.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We performed a single-centre retrospective study that included patients with LV ejection fraction (LVEF) < 50% who had been consecutively referred for cardiopulmonary exercise testing (CPET) from 2016-2020. Loop gain was measured through computational evaluation of the minute ventilation graph. The primary endpoint was a composite of cardiovascular (CV) death (sudden death, progressive heart failure–related death and electric storm), urgent heart transplantation/left ventricular assist device (LVAD) implantation or HF hospitalization.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Of the 250 patients included (mean age 58years, 75% male, 67% with ischemic HF), the 66 that presented EOV also had increased value of loop gain when compared to patients without EOV. Those with increased loop gain had more severe HF, higher NT-proBNP and VE/VCO2 slope as well as lower pVO2 and LVEF. On multivariate cox regression analysis, loop gain showed significant correlation with time to composite endpoint (HR for 1 point increase in loop gain 6,866; 95% CI 1,724-27,341; p=0,006), even when adjusted for pVO2, VE/VCO2 slope, log transformation of NTproBNP and LVEF. Presence of EOV was not prognostically significant in this analysis. The prognosis of patients with lower loop gain seems to be better while patients with higher loop gain seem to fare worse, regardless of the presence of EOV. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Loop gain is an objective parameter that quantifies ventillatory instability and showed to have a strong prognostic value in a cohort of patients with HF and LVdysfunction, outperforming the classification of EOV.</span></span></p>
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