Capacidade Preditiva dos Parâmetros do Teste de Esforço Cardiopulmonar em Pacientes com Insuficiência Cardíaca em Terapia de Ressincronização Cardíaca

Reis, João Ferreira; Gonçalves, António Valentim; Bras, P Garcia; Moreira, Rita Ilhão; Rio, Pedro; Timóteo, Ana Teresa; Soares, Rui; Ferreira, Rui Cruz

doi:10.36660/abc.20210620

Cited by 3 publications

(5 citation statements)

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“…This cut-off was a strong predictor of HF outcomes, and the authors conclude that a pVO 2 of ≤10 mL/kg/min rather than the traditional cut-off value may be more useful for risk stratification in the device era [ 21 ]. Nevertheless, there are conflicting data [ 46 ] and, in the latest guidelines, the ISHLT recommends maintaining the currently accepted pVO 2 values [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?

et al. 2023

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Background: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). Methods: Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. Results: CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO2 (pVO2) and VE/VCO2 slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO2 slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO2 ≤ 10 mL/kg/min and VE/VCO2 slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. Conclusion: ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?

et al. 2023

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“…9,11 Knowledge of this scenario is scarce, and some evidence suggests a less important role of peak VO 2 in these patients in the selection for heart transplantation. 12 In the study by Reis et al, 10 VO 2 peak, VE/VCO2 slope, PET CO2 and P ET CO2 LA were able to predict outcomes in patients with HF and CRT in uni-and multivariable analyses. 10 However, in the ROC curve analysis, P ET CO2 LA apparently showed superior accuracy for predicting events.…”

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confidence: 93%

“…12 In the study by Reis et al, 10 VO 2 peak, VE/VCO2 slope, PET CO2 and P ET CO2 LA were able to predict outcomes in patients with HF and CRT in uni-and multivariable analyses. 10 However, in the ROC curve analysis, P ET CO2 LA apparently showed superior accuracy for predicting events. Interestingly, the optimal cut-off point was 33 mmHg, lower than the 36 mmHg in previous studies that evaluated this variable.…”

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confidence: 93%

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confidence: 99%

“…In this issue of Arquivos Brasileiros de Cardiologia, Reis et al 10 present an interesting analysis of the prognostic role of CPET in a cohort of 450 patients, 114 of whom underwent CRT. 10 The patients were followed up for 2 years, and the evaluated outcome was cardiovascular mortality and the need for urgent transplantation. The classic evaluation studies for heart transplantation 9,11 involving CPET do not include patients with CRT, which makes it important to question how the behavior of prognostic variables would be in this context.…”

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Medida do PETCO2 no Limiar Anaeróbico: Melhor Marcador Prognóstico em Pacientes com Ressincronizador?

Silveira¹,

Pimentel²

2022

Arquivos Brasileiros De Cardiologia

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Prognostic Value of Cardiopulmonary Exercise Test in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

Li,

Fan,

et al. 2024

Preprint

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Objectives: To determine the independent risk factors of cardiopulmonary exercise test (CPET) parameters related to adverse prognostic events within 5 years in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and establish a prediction model for the occurrence of adverse events within 5 years to provide a reference for cardiac rehabilitation training. Methods: From August 2015 to December 2021, patients who underwent PCI for AMI and completed CPET within 1–2 weeks after surgery before discharge from the Department of Cardiovascular Medicine of Zhengzhou Central Hospital Affiliated to Zhengzhou University, Henan Provincial Hospital of Traditional Chinese Medicine, and Anyang District Hospital were selected as participants. Univariate and multivariate analyses were used to screen for independent risk factors associated with 5-year adverse events. Feature importance was interpreted using SHapley Additive exPlanations (SHAP), and a logistic regression model was established for prediction. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of the prediction model. Calibration was assessed by the Hosmer-Lemeshow test and the calibration curve. Results: In total, 375 patients met the inclusion criteria, including 53 in the event group and 322 in the non-event group, according to whether adverse events occurred during the 5-year follow-up period. Peak oxygen uptake (peakVO2), carbon dioxide ventilation equivalent slope (VE/VCO2slop), and peak end-tidal carbon dioxide partial pressure (PETCO2) were three independent risk factors for re-acute myocardial infarction (re-AMI), heart failure (HF), and even death after PCI for AMI (P < 0.05). The SHAP plots demonstrated that the significant contributors to model performance were related to peakVO2, VE/VCO2slop, and PETCO2. The risk of adverse events was significantly reduced when the peakVO2 was ≥ 20 ml/kg/min and the VE/VCO2slop was < 33. The ROC curves of the three models were drawn, including the no-event and event groups, re-AMI group, and HF group, which performed well, with AUC of 0.894, 0.760, and 0.883, respectively. The Hosmer-Lemeshow test showed that the three models were a good fit (P > 0.05). The calibration curve of the three models was close to the ideal diagonal lines. Conclusions: CPET parameters can predict the prognosis of adverse events within 5 years after PCI in patients with AMI and provide a theoretical basis for cardiac rehabilitation training.

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Capacidade Preditiva dos Parâmetros do Teste de Esforço Cardiopulmonar em Pacientes com Insuficiência Cardíaca em Terapia de Ressincronização Cardíaca

Cited by 3 publications

References 29 publications

Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?

Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?

Medida do PETCO2 no Limiar Anaeróbico: Melhor Marcador Prognóstico em Pacientes com Ressincronizador?

Prognostic Value of Cardiopulmonary Exercise Test in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

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