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Exercise intensity prescription in heart failure patients: comparison of different physiological parameters
Session:
Sessão de Posters 48 - Exercício, Estilos de Vida e Obesidade
Speaker:
David Sá Couto
Congress:
CPC 2024
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Cartazes
FP Number:
---
Authors:
David Sá Couto; Inês Lopes; Maria Isilda Oliveira; Cristine Schmidt; Sandra Magalhães; Helder Dores; Fernando Ribeiro; Mário Santos
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Introduction and aims:</span></span></u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"> Aerobic exercise intensity (EI) prescription is critical for the efficacy and safety of heart failure (HF) patients’ cardiac rehabilitation programs. Usually, percentages of maximal physiological parameters are used to categorize EI domains (low, moderate, high, and very-high). The definition of these domains has not been adequately addressed for HF patients, as well as their correspondence with the ventilatory thresholds (VT) assessed by cardiopulmonary exercise test (CPET). We aimed to study the consistency among the commonly used physiological variables (% peak oxygen uptake (VO<sub>2</sub>), % peak heart rate (HR) and % heart rate reserve (HRR)) in the classification within different EI domains, and their correspondence to the first VT (VT1) in patients with HF.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Methods:</span></span></u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"> We retrospectively analysed data from 163 HF patients across left ventricle ejection fraction (LVEF) spectrum who underwent a maximal CPET. Percentages of peak VO<sub>2</sub>, peak HR and HRR were obtained at VT1. VT1 was considered to correspond to moderate EI. To each parameter, we compared the classification within the different EI domains at VT1 (defined by the current guidelines) and assessed the rate of correspondence to the moderate EI domain. Two subgroup analyses were done, stratifying patients according to their LVEF and according to their overall physical fitness and exercise capacity.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Results:</span></span></u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"> Of the 163 patients included in the analysis, 64% were male and the mean age was 61 years. Regarding the HF phenotype, 66% had reduced LVEF. Ischemic heart disease was the cause of HF in 38% of the cases. VT1 was observed at 82±10% of peak HR, 54±25% of HRR and 54±17% of peak VO<sub>2</sub>, corresponding to the high intensity for % peak HR, and moderate intensity domain for % HRR and % peak VO<sub>2</sub>. Using % peak VO<sub>2</sub>, 65% of the patients were classified in the correct EI domain (moderate intensity) at VT1 but this dropped to 46% when using % HRR and to 25% using % peak HR (Figure 1). Appropriate classification at VT1 was superior in patients with reduced LVEF and in patients with higher exercise capacity.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Conclusion:</span></span></u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"> The present study shows the accuracy of EI prescription in HF patients across the LVEF spectrum based on a threshold-based approach, when compared to the other indices. In at least 1 out of 3 patients, EI will be misclassified if guided by current guideline recommended physiologic parameters, emphasizing the relevance of a CPET to an adequate exercise prescription in HF patients.</span></span></span></span></span></p>
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