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Predictive Value of Cardiopulmonary Exercise Testing Parameters in Patients under Percutaneous Coronary Intervention
Qiang Ren1,2, Xingbo Mu1,2, Yushan Li1
1State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 110016 Shenyang, Liaoning, China.
Insights
Cardiopulmonary exercise testing (CPET) parameters like peak oxygen uptake and ventilatory equivalent for carbon dioxide predict outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) and high pulse pressure (PP). These CPET metrics offer valuable prognostic insights for high-risk CAD patients.
Area of Science:
- Cardiology
- Exercise Physiology
- Medical Prognostics
Background:
- High pulse pressure (PP) in patients undergoing percutaneous coronary intervention (PCI) presents unclear prognostic implications.
- Coronary artery disease (CAD) management requires better understanding of risk stratification in specific patient subgroups.
Purpose of the Study:
- To investigate the correlation between cardiopulmonary exercise testing (CPET) parameters and prognosis in patients with CAD undergoing PCI and high PP.
- To assess the predictive value of CPET parameters for major adverse cardiovascular events (MACE) in this population.
Main Methods:
- Retrospective analysis of 2785 patients (aged ≥18) who underwent PCI and CPET between November 2015 and September 2021.
- Patients were stratified into high PP (males ≥50 mmHg, females ≥60 mmHg) and normal PP groups.
- Cox regression and time-dependent ROC curve analyses identified predictors of MACE.
Main Results:
- Peak oxygen uptake (peak VO2) and ventilatory equivalent for carbon dioxide (VE/VCO2) were identified as significant predictors of MACE.
- Multifactorial analysis revealed peak VO2 (HR: 0.94) and VE/VCO2 (HR: 1.08) as key CPET prognostic factors.
- A ROC model incorporating DM, smoking, peak VO2, and VE/VCO2 demonstrated good discriminatory ability for 1, 3, and 5-year prognoses.
Conclusions:
- Patients with CAD undergoing PCI and high PP exhibit a worse prognosis compared to those with normal PP.
- Peak VO2 and VE/VCO2 are crucial predictors of MACE in CAD patients with high PP.
- CPET parameters provide valuable prognostic information for risk-stratifying patients with high PP undergoing PCI.
Background:
The correlation between cardiopulmonary exercise testing (CPET) parameters and the prognosis of patients undergoing percutaneous coronary intervention (PCI) with high pulse pressure (PP) is unclear. The purpose of present study is to investigate the correlation of CPET parameters in patients under PCI with high PP and assess their reference value for prognosis.
Methods:
Individuals aged 18 years and older who were diagnosed with coronary artery disease (CAD) and underwent PCI along with CPET from November 1, 2015 to September 30, 2021 were enrolled. The patients were categorized into two groups based on PP: high PP group (PP of males ≥50 mmHg; PP of females ≥60 mmHg) and normal PP group (PP of males <50 mmHg; PP of females <60 mmHg). The primary endpoint was major adverse cardiovascular events (MACE). The optimal predictors of MACE were identified through Cox regression analysis. The time-dependent receiver operating characteristic (ROC) curves were generated and the area under the ROC curve (AUC) was measured to evaluate the discriminatory ability in patients with high PP.
Results:
A total of 2785 patients were included in present study, with a median follow-up period of 1215 (687-1586) days. Through multifactorial analysis, it was determined that peak oxygen uptake (peak VO2, hazard ratio (HR): 0.94, 95% confidence interval (95% CI): 0.88 to 1.00, p = 0.038) and ventilatory equivalent for carbon dioxide (VE/VCO2, HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.007) are important predictive factors in the parameters of CPET. The ROC based on diabetes mellitus (DM), smoking, peak VO2, and VE/VCO2 could effectively evaluate the prognosis of patients [1-year AUC: 0.636 (0.515~0.758), 3-year AUC: 0.675 (0.599~0.752), 5-year AUC: 0.718 (0.607~0.830)].
Conclusions:
The prognosis of CAD patients with high PP was worse compared to the patients with normal PP. The peak VO2 and VE/VCO2 were predictors of MACE in CAD patients with high PP.
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