Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study.
<h4>Objective</h4>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, VO2) after CR in su...
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oai:doaj.org-article:b44890311ac0473ea7f781a018352d562021-12-02T20:15:19ZChanges and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study.1932-620310.1371/journal.pone.0255477https://doaj.org/article/b44890311ac0473ea7f781a018352d562021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255477https://doaj.org/toc/1932-6203<h4>Objective</h4>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, VO2) after CR in surgical compared to non-surgical cardiac patients.<h4>Methods</h4>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 VO2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought.<h4>Results</h4>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 VO2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin.<h4>Conclusion</h4>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.<h4>Trial registration</h4>Netherlands Trial Register, Trial NL5166.Thimo MarcinPrisca EserEva PrescottLeonie F PrinsEvelien KolkmanWendy BruinsAstrid E van der VeldeCarlos Peña GilMarie-Christine IliouDiego ArdissinoUwe ZeymerEsther P MeindersmaArnoud W J Van't HofEd P de KluiverMatthias WilhelmPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255477 (2021) |
| institution |
DOAJ |
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DOAJ |
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EN |
| topic |
Medicine R Science Q |
| spellingShingle |
Medicine R Science Q Thimo Marcin Prisca Eser Eva Prescott Leonie F Prins Evelien Kolkman Wendy Bruins Astrid E van der Velde Carlos Peña Gil Marie-Christine Iliou Diego Ardissino Uwe Zeymer Esther P Meindersma Arnoud W J Van't Hof Ed P de Kluiver Matthias Wilhelm Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. |
| description |
<h4>Objective</h4>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, VO2) after CR in surgical compared to non-surgical cardiac patients.<h4>Methods</h4>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 VO2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought.<h4>Results</h4>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 VO2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin.<h4>Conclusion</h4>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.<h4>Trial registration</h4>Netherlands Trial Register, Trial NL5166. |
| format |
article |
| author |
Thimo Marcin Prisca Eser Eva Prescott Leonie F Prins Evelien Kolkman Wendy Bruins Astrid E van der Velde Carlos Peña Gil Marie-Christine Iliou Diego Ardissino Uwe Zeymer Esther P Meindersma Arnoud W J Van't Hof Ed P de Kluiver Matthias Wilhelm |
| author_facet |
Thimo Marcin Prisca Eser Eva Prescott Leonie F Prins Evelien Kolkman Wendy Bruins Astrid E van der Velde Carlos Peña Gil Marie-Christine Iliou Diego Ardissino Uwe Zeymer Esther P Meindersma Arnoud W J Van't Hof Ed P de Kluiver Matthias Wilhelm |
| author_sort |
Thimo Marcin |
| title |
Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. |
| title_short |
Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. |
| title_full |
Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. |
| title_fullStr |
Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. |
| title_full_unstemmed |
Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. |
| title_sort |
changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: the eu-care observational study. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/b44890311ac0473ea7f781a018352d56 |
| work_keys_str_mv |
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