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Cardiac rehabilitation after acute coronary syndrome: Do all patients derive the same benefit?
Sílvia Aguiar Rosa1, Ana Abreu1, Rui Marques Soares1
1Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal.
Insights
Patients with lower baseline peak oxygen uptake (pVO2) showed greater functional capacity improvements with cardiac rehabilitation (CR). Cardiopulmonary exercise testing (CPET) can identify these patients for optimized CR benefits.
Area of Science:
- Cardiology
- Exercise Physiology
- Rehabilitation Medicine
Background:
- Cardiac rehabilitation (CR) improves exercise capacity in acute coronary syndrome (ACS) patients.
- Patient selection is key as not all patients benefit equally from CR.
Purpose of the Study:
- To identify ACS patients who gain the most functional capacity (FC) benefit from CR using cardiopulmonary exercise testing (CPET).
- To assess the utility of CPET in predicting CR response in ACS patients.
Main Methods:
- Retrospective analysis of 129 ACS patients undergoing CR and CPET.
- CPET assessed peak oxygen uptake (pVO2), VE/VCO2 slope, and peak circulatory power (PCP) at baseline and post-CR.
- Patients stratified by baseline pVO2 (<20 ml/kg/min vs. ≥20 ml/kg/min) and ejection fraction (<50% vs. ≥50%).
Main Results:
- All patients improved FC post-CR.
- Patients with lower baseline pVO2 (<20 ml/kg/min) demonstrated significantly greater increases in pVO2 (ΔpVO2).
- Significant improvements in CPET parameters, including pVO2 and exercise duration, were observed across ejection fraction groups.
Conclusions:
- Lower baseline pVO2 (<20 ml/kg/min) predicts greater functional capacity improvement after CR in ACS patients.
- CPET is a valuable tool for identifying ACS patients likely to benefit most from CR, even if not routinely used.
- Optimizing patient selection for CR can maximize resource effectiveness.
Introduction:
Cardiac rehabilitation (CR) has been demonstrated to improve exercise capacity in acute coronary syndrome (ACS), but not all patients derive the same benefit. Careful patient selection is crucial to maximize resources.
Objective:
To identify in a heterogeneous ACS population which patients would benefit the most with CR, in terms of functional capacity (FC), by using cardiopulmonary exercise testing (CPET).
Methods:
A retrospective analysis of consecutive ACS patients who underwent CR and CPET was undertaken. CPET was performed at baseline and after 36 sessions of exercise. Peak oxygen uptake (pVO2), percentage of predicted pVO2, minute ventilation/CO2 production (VE/VCO2) slope, VE/VCO2 slope/pVO2 and peak circulatory power (PCP) (pVO2 times peak systolic blood pressure) were assessed in two moments. The differences in pVO2 (ΔpVO2), %pVO2, PCP and exercise test duration were calculated. Patients were classified according to baseline pVO2 (group 1, <20 ml/kg/min vs. group 2, ≥20 ml/kg/min) and left ventricular ejection fraction (group A, <50% vs. group B, ≥50%).
Results:
We analyzed 129 patients, 86% male, mean age 56.3±9.8 years. Both group 1 (n=31) and group 2 (n=98) showed significant improvement in FC after CR, with a more significant increase in pVO2, in group 1 (ΔpVO2 4.4±7.3 vs. 1.6±5.4; p=0.018). Significant improvement was observed in CPET parameters in group A (n=34) and group B (n=95), particularly in pVO2 and test duration.
Conclusion:
Patients with lower baseline pVO2 (<20 ml/kg/min) presented more significant improvement in FC after CR. CPET which is not routinely used in assessement before CR in context of ACS, could be a valuable tool to identify patients who will benefit the most.
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