Prognostic value of aerobic capacity and exercise oxygen pulse in postaortic dissection patients

Abstract

Background Although recommendations encourage daily moderate activities in post aortic dissection, very little data exists regarding cardiopulmonary exercise testing (CPET) to personalize those patient's physical rehabilitation and assess their cardiovascular prognosis. Design We aimed at testing the prognostic insight of CPET regarding aortic and cardiovascular events by exploring a prospective cohort of patients followed‐up after acute aortic dissection. Methods Patients referred to our department after an acute (type A or B) aortic dissection were prospectively included in a cohort between September 2012 and October 2017. CPET was performed once optimal blood pressure control was obtained. Clinical follow‐up was done after CPET for new aortic event and major cardio‐vascular events (MCE) not directly related to the aorta. Results Among the 165 patients who underwent CPET, no adverse event was observed during exercise testing. Peak oxygen pulse was 1.46(1.22‐1.84) mlO2/beat, that is, 97 (83–113) % of its predicted value, suggesting cardiac exercise limitation in a population under beta blockers (92% of the population). During a follow‐up of 39(20‐51) months from CPET, 42 aortic event recurrences and 22 MCE not related to aorta occurred. Low peak oxygen pulse (<85% of predicted value) was independently predictive of aortic event recurrence, while low peak oxygen uptake (<70% of predicted value) was an independent predictor of MCE occurrence. Conclusion CPET is safe in postaortic dissection patients should be used to not only to personalize exercise rehabilitation, but also to identify those patients with the highest risk for new aortic events and MCE not directly related to aorta.

A scoping review of exercise-based cardiac rehabilitation for patients with aortic dissection

“…Only 11 eligible studies were included in this scoping review, the publication time of these articles were relatively new, randomized controlled trials were few, and these researches were mostly concentrated in Europe, Asia and North America, showing the paucity of literature on this topic. However, we also found [21] To test the prognostic significance of CPET regarding aortic and cardiovascular events.…”

“…Therefore, it is very necessary to use CPET to evaluate the tolerance and safety of ECR in patients with AD. Delsart et al [21] and Hornsby et al [22] proved that CPET was safe in patients with AD. In addition, it can identify those patients with the highest risk for new aortic events.…”

“…Table 4 showed nine researches of ECR for patients with AD [18][19][20][21][22][23][24][25][26], which were described from four aspects, including the purpose of study, the programs of ECR, the effectiveness of exercise and the safety of exercise. In view of the main types of ECR were listed, so only the purpose of study, the effectiveness of exercise and the safety of exercise were discussed below.…”

“…Cardiopulmonary exercise testing (CPET) is the gold standard for the evaluation of exercise capacity, which can comprehensively evaluate the overall function and reserve capacity of the organ system such as the heart and lung [27]. Two studies were conducted to evaluate the safety of CPET and to test the prognostic significance of CPET regarding aortic and cardiovascular events [21,22]. The two studies included a control group that did not perform standard ECR programs [23,24].…”

“…Castañeda-López et al [19] pointed physical training programs such as methods for exercise prescription (cardiopulmonary stress test) are safe. CPET is safe in post AD patients should be used to not only to personalize exercise rehabilitation, but also to identify those patients with the highest risk for new aortic events and major cardio-vascular events not directly related to aorta [21].…”