Open AccessChanges and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study
Author(s) -
Thimo Marcin,
Prisca Eser,
Eva Prescott,
Leonie F Prins,
Evelien Kolkman,
Wendy Bruins,
Astrid E van der Velde,
Carlos Peña-Gil,
MarieChristine Iliou,
Diego Ardissino,
Uwe Zeymer,
Esther P. Meindersma,
Arnoud W.J. van‘t Hof,
Ed P de Kluiver,
Matthias Wilhelm
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0255477
Subject(s) - medicine , mace , rehabilitation , vo2 max , cardiology , cardiac surgery , observational study , prospective cohort study , receiver operating characteristic , percutaneous coronary intervention , physical therapy , surgery , heart rate , myocardial infarction , blood pressure
Objective We aimed 1) to test the applicability of the previously suggested prognostic value of CPET to elderly cardiac rehabilitation patients and 2) to explore the underlying mechanism of the greater improvement in exercise capacity (peak oxygen consumption, VO 2 ) after CR in surgical compared to non-surgical cardiac patients. Methods Elderly patients (≥65 years) commencing CR after coronary artery bypass grafting, surgical valve replacement (surgery-group), percutaneous coronary intervention, percutaneous valve replacement or without revascularisation (non-surgery group) were included in the prospective multi-center EU-CaRE study. CPETs were performed at start of CR, end of CR and 1-year-follow-up. Logistic models and receiver operating characteristics were used to determine prognostic values of CPET parameters for major adverse cardiac events (MACE). Linear models were performed for change in peak VO 2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought. Results 1421 out of 1633 EU-CaRE patients performed a valid CPET at start of CR (age 73±5.4, 81% male). No CPET parameter further improved the receiver operation characteristics significantly beyond the model with only clinical parameters. The higher improvement in peak VO 2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin. Conclusion CPET did not improve the prediction of MACE in elderly CR patients. The higher improvement of exercise capacity in surgery patients was mainly driven by restoration of haemoglobin levels and improvement in respiratory function after sternotomy. Trial registration Netherlands Trial Register, Trial NL5166 .