SPC365

The role of peak VO2 in prognosis in patients undergoing a Cardiac Rehabilitation program

Session: Posters (Sessão 5 - Écran 8) - Reabilitação cardíaca
Speaker: Pedro Alves Da Silva

Congress: CPC 2023
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Pedro Alves Da Silva; Inês Aguiar-Ricardo; Ana Margarida Martins; Joana Brito; Catarina Oliveira; Beatriz Garcia; Ana Abrantes; Miguel Raposo; Catarina Gregório; Sandra Miguel; Laura Santos; Nelson Cunha; Fausto J. Pinto

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Introduction:</span></span></strong> <span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212121">Peak oxygen uptake (peak VO2) is a strong predictor of mortality and is commonly used in the evaluation of patients for cardiac transplantation.&nbsp;</span></span></span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Although guidelines suggest a peak VO2&lt;14mL/(kg.min) as a cut-off for transplant and a peak VO2&lt;12mL/(kg.min) in patients under beta-blockade (BB), recent data emerged, questioning the suitability of such cut-offs.</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Purpose</span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">: To correlate CPET and echo data with outcomes after CR programs and to determine the best cut off for peak VO2 in a population with a high percentage of BB therapeutics.</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Methods</span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">: Single center p<span style="background-color:white">rospective study which included consecutive pts who were participating in a centre-based CR program lasting 8-12 weeks from 2019 to 2021. The CR program included initial evaluation by cardiologist and rehabilitation specialist with collection of clinical characteristics, three times weekly supervised exercise sessions, appointment with rehabilitation nurse, nutritionist and psychologist and educational sessions. Lab tests, echocardiogram and CPET were done before and after completion of the program. Multivariate analysis with Cox regression was used to correlate with events and survival was analysed with Kaplan Meier curves.</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Results: </span></span></span></strong><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">We analysed 349 patients who underwent CR (82% male, mean age 60 &plusmn;11,4 years). The majority was referred for ischemic heart disease (83%) followed by valvular heart disease (7%). Mean follow-up was 36,7</span></span></span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">&plusmn;<span style="background-color:white"> 19,2 months. During FUP, 7,2% pts had CV related admissions (n=25), 4 of which were myocardial infarction. Sixteen pts died (4,6%) of which 2,3% were from cardiovascular causes. </span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">On multivariate analysis peak VO2 (HR </span></span></span><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">0.827 CI 95% 0.72-0.949, p=0.07), ejection fraction (HR 0.962 CI 95% 0.933-0.991, p=0.01) and test duration (HR 0.756 CI 95% 0.712-0.778, p=0.01) correlated with hospital admissions. Regarding mortality only peak VO2 showed statistical significance (HR 0.8 CI 95% 0.69-0.93, p=0.04). On this matter we further analysed the best cut-off in predicting events: a peak VO2 &gt; 14 mL/(kg.min) was a better predictor of event free-survival in these patients when comparing with a peak VO2 of 12 mL/(kg.min) &ndash; figure 1<span style="background-color:white">.</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusions: </span></span></span></strong><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Cardiac rehabilitation has an established impact in prognosis.</span></span></span> <span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Echo and CPET data obtained at the beginning of the CR program can be used to identify patients who might benefit from a more closed surveillance in order to reduce risks of hospitalization.<br />
Moreover, in our population, a peak VO2 cut-off of 14mL/(kg.min) seemed to better correlate with event-free survival.&nbsp;</span></span></span></span></span></p>