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Accuracy and Prognostic Value of Calculated Versus CPET-Derived METs in Phase II Cardiac Rehabilitation
Session:
Sessão de Posters 35 - Medir o que importa na reabilitação cardíaca
Speaker:
Sofia Esteves
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Sofia Esteves; João Cravo; Catarina Sena Silva; Daniel Inácio Cazeiro; Inês Araújo; Paula Sousa; Alda Jordão; Inês Aguiar-Ricardo; Nelson Cunha; Pedro Alves da Silva; Fausto J. Pinto; Ana Abreu
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Cardiac rehabilitation (CR) programs frequently rely on estimated metabolic equivalents (METs) derived from exercise testing formulas; however, the accuracy and clinical validity of these calculated METs relative to directly measured values remains uncertain.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">:</span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To evaluate the agreement between calculated METs and cardiopulmonary exercise test (CPET)-derived METs, and to assess their prognostic implications.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">We conducted an observational, single-center study with patients enrolled in a phase II CR program between 2015 and 2025. CPETs performed at admission and after completion of the program were analyzed. CPET-derived METs were calculated as peak VO</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><sub>2 </sub></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">divided by 3.5. Estimated METs were obtained using the “Cycle Ergometer Metabolic Calculator”. Agreement between both methods was assessed using Pearson correlation, intraclass correlation coefficients (ICC), and Bland–Altman analyses. Prognostic performance was evaluated using ROC analysis to identify optimal MET cutoffs and Cox proportional hazards models for all-cause mortality and hospitalization.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Of 697 patients, 567 (81%) were included (total 842 CPETs, mean age 61 years, 80% male). Mean estimated and CPET-derived METs were 5.9 and 4.5 pre-CR, and 6.5 and 5.0 post-CR, respectively. Although correlations were strong in both CPETs (r=0.843 and 0.877; p<0.001), agreement was only moderate (ICC 0.55 and 0.59). Bland-Altman plots demonstrated substantial positive bias (+1.4 and +1.5 METs), with wide limits of agreement (~0 to +3 METs). In the pre-CR CPET, estimated METs predicted mortality with an ROC-derived cutoff of 4.6 METs (HR 0.54, 95% CI 0.32-0.91, p=0.02). CPET-derived METs showed a similar result (HR 0.55, 95% CI 0.34-0.89, p=0.014) but at a lower cutoff of 4.0 METs, indicating systematic overestimation by estimated values.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Although calculated METs correlate strongly with CPET-derived METs, their moderate agreement, systematic overestimation, and altered prognostic thresholds may limit their reliability for individual clinical assessment and risk stratification.</span></span></span></p>
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