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A Matter of Power – the Prognostic Value of Peak Circulatory Power Across the Ejection Fraction Spectrum
Session:
Sessão de Posters 35 - Medir o que importa na reabilitação cardíaca
Speaker:
Catarina Sena Silva
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.1 Exercise Testing
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Catarina Sena Silva; Marta Vilela; Daniel Inácio Cazeiro; Diogo Ferreira; João Cravo; Gisela Afonso; Marta Ramalhinho; Inês Aguiar-Ricardo; Pedro Alves da Silva; Nelson Cunha; 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>Background</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Peak circulatory power (PCP), a CPET-derived index obtained by the product of peak oxygen consumption and peak systolic arterial pressure, has been proposed as a prognostic marker in several heart-failure phenotypes. Whether PCP predicts mortality across the full left-ventricular ejection–fraction (LVEF) spectrum remains insufficiently defined.</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>Aim</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To investigate the ability of PCP to predict mortality in an unselected population entering a phase II cardiac rehabilitation (CR) program.</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 retrospectively analyzed patients enrolled in a phase II CR program from 2015 to 2025 who completed CPET prior to initiation. ROC analysis was used to evaluate the discriminative ability of peak PCP and identify an optimal cutoff for mortality prediction. Survival was assessed using Kaplan–Meier curves and Cox proportional-hazards models.</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">A total of 479 patients were included (mean age 61 years; 80% male; mean LVEF 50%). Over a mean follow-up of 2.5 years, 20 deaths occurred. Peak PCP demonstrated fair discriminatory power for mortality (AUC 0.64), with an optimal threshold of <2300 mL/kg/min·mmHg, yielding 68% sensitivity and 63% specificity. Patients below this cutoff exhibited significantly higher mortality (log-rank p=0.006). PCP <2300 mL/kg/min·mmHg was associated with increased mortality on univariate analysis (HR 3.350, 95% CI 1.335–8.404, p=0.01) and remained an independent predictor after adjustment age, sex and LVEF (HR 2.985, 95% CI 1.040–8.567, p=0.042).</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>Conclusions</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">In our cohort, PCP is a predictor of all-cause mortality, regardless of LVEF. A low PCP (<2300 mL/kg/min·mmHg) identifies individuals at substantially elevated risk, reinforcing its role as a simple, noninvasive CPET-derived metric for prognostic assessment. Larger, prospective studies are warranted to validate these observations and clarify its potential integration into routine risk stratification</span></span></span></p>
Slides
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