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The Role of CPET for the Assessment of patients with Transthyretin Amyloid Cardiomyopathy
Session:
SESSÃO DE POSTERS 25 - ALÉM DA RECUPERAÇÃO - AVANÇANDO AS FRONTEIRAS DA REABILITAÇÃO CARDÍACA
Speaker:
Débora Da Silva Correia
Congress:
CPC 2025
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.1 Exercise Testing
Session Type:
Cartazes
FP Number:
---
Authors:
Débora Da Silva Correia; Rita Almeida Carvalho; Rita Amador; Rita Barbosa; Samuel Azevedo; Sérgio Maltês; Tânia Laranjeira; Miguel Mendes; Bruno Rocha; Carlos Aguiar; Gonçalo Cunha
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>[Introduction]:</u> Cardiopulmonary exercise testing (CPET) is a well-established tool for assessing functional capacity but is underutilized in Transthyretin Amyloid Cardiomyopathy<strong> </strong>(ATTR-CM). We aimed to evaluate the correlation between CPET parameters and ATTR-CM disease stage and the the potential prognostic value of CPET in these patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>[Methods]</u>: This is a single-centre study of ATTR-CM patients diagnosed followed in our dedicated rare disease program whom underwent CPET since November 2019. ATTR-CM was confirmed as per the recommended non-invasive algorithm. Patients performed CPET on a treadmill using an exercise protocol with progressive increase in workload. The test was considered to be maximal if a respiratory exchange ratio (RER) ≥1.05 was obtained. ATTR-CM severity was classified as per the Gilmore staging system and patients were grouped as follows: stage I [NT-proBNP ≤3000ng/L and estimated glomerular filtration rate (eGFR) ≤45mL/min) or stage II/III (NT-proBNP >3000ng/L and/or eGFR <45mL/min). The primary endpoint of interest was a composite of all-cause death, cardiovascular hospitalization or emergency room visits.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>[Results]</u>: We analysed CPET data from 47 patients (mean age 83 ± 6 years, 85% male, 53% stage I) diagnosed with ATTR-CM. The mean duration of CPET was 7.7±3.2 minutes and it was maximal in 43% (n=20) of patients. Compared to those in stage I, patients in stage II/III had worse CPET parameters, as noted by a lower peak oxygen consumption (pVO<sub>2</sub>) (13 ± 3 <em>vs.</em> 15 ± 4mL/kg/min, <em>p</em>=0,025) and the presence of exercise oscillatory ventilation (EOV) (41% <em>vs.</em> 8%, <em>p</em>=0,008), lower percentage of predicted peak heart rate (82 ± 19% <em>vs.</em> 99 ± 2%, <em>p</em>=0.004) and reduced heart rate reserve (9 [IQR 12] vs. 14 [IQR 26] bpm, p=0.008). A total of 20 (43%) patients met the composite outcome at a median follow-up of 21 months. Stage II/III patients had higher rates of death (4% <em>vs.</em> 1%, p=0.002) and cardiovascular hospitalization (46% vs. 16%, <em>p=</em>0.042). Univariable analysis identified pVO2 <16ml/kg/min (Weber class C and D) and O<sub>2</sub> pulse as predictive of the primary endpoint.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>[Conclusion]</u>: CPET in feasible in patients with ATTR-CM and correlates well with disease severity, as per the Gillmore staging system. The role of CPET in the prognostic evaluation warrants further investigation in a properly conducted multicentre prospective study.</span></span></p>
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