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Predictors of functional improvement after a Phase II Cardiac Rehabilitation Program: is left ventricular ejection fraction at baseline a limiting factor?
Session:
Posters (Sessão 5 - Écran 8) - Reabilitação cardíaca
Speaker:
Fabiana Duarte
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:
Fabiana Silva Duarte; Inês Ricardo; Clarissa Faria; Pedro Silva; Nelson Cunha; Sandra Miguel; Paula Sousa; Edite Caldeira; Rita Pinto; Fausto Pinto; Ana Abreu
Abstract
<p>Introduction: Cardiac rehabilitation program (CRP) is a multidisciplinary intervention tailored to improve functional fitness in different cardiovascular conditions. Patients with reduced left ventricular ejection fraction (LVEF) are commonly unrepresented hence the impact of LVEF on functional fitness is uncertain.</p> <p>Purpose: To evaluate changes on functional capacity in a cohort of patients referred to a CRP, according to baseline LVEF.</p> <p>Methods: Tertiary-center retrospective analysis of patients referred to an exercise-based phase II CRP. To be enrolled patients had to complete a 12-weeks CRP and to perform a symptom-limiting cardiopulmonary exercise test (CPET), at the beginning and at the end of the program. Patients were stratified into a reduced (LVEF < 45%) or preserved (LVEF ≥ 45%) group. Four CPET parameters were evaluate: peak oxygen uptake (pVO2), predicted-pVO2 (ppVO2), O2 pulse and VE/VCO2 slope.</p> <p>Results: 127 patients (mean age 57.8 ± 11.2 years; males 79.5%) were eligible for CRP, of which 86.6% were referred following an acute coronary event. Patients included in the reduced LVEF group (38.6%; mean LVEF 31% ± 8.1) had more dyslipidemia (48.8% vs 22.8%, p=0.013), atrial fibrillation (24.5% vs 7.7%, p=0.008) and implanted electronic devices with defibrillator (30.6% vs 2.6%, p<0.001).<br /> Regarding CPET parameters, reduced LVEF patients had a lower pVO2 (mean dif 2, p=0.048), ppVO2 (mean dif 12.1%, p<0.001) and O2 pulse value (mean dif 2, p=0.049) vs higher values of VE/VCO2 slope (mean dif 2.9, p=0.036). The Weber and ARENA classifications analysis revealed similar distribution between groups: 24.4% of reduced vs 27.5% of preserved patients entering CRP had a low Weber class (C or D). Higher ARENA class (III-IV) included 28.5% of patients with reduced and 14.1% with preserved LVEF.<br /> At the end of the rehabilitation program, changes on CPET parameters were similar between reduced and preserved groups: ppVO2 increased by 4% vs 3.2% (p=0.808), O2 pulse increased about 0.7 vs 0.5 mL/beat (p=0.509) and VE/VCO2 slope reduces 1.7 vs 0.3 (p=0.232). As a continuous variable, LVEF did not predict Weber´s (p=0.546) or ARENA (p=0.393) class changes. Yet, those with a reduced baseline LVEF derived a greater LVEF improvement after CRP (Δ 10.2 ± 9.8 vs Δ 2.2 ± 7.9; p<0.001)</p> <p>Conclusions: All patients enrolled in CRP show improvement of exercise capacity irrespective of baseline LVEF. Thus, patients with reduced LVEF should not be denied for cardiac rehabilitation and a significant LVEF improvement is expected.</p>
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