Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study

PLoS One. 2021 Aug 3;16(8):e0255477. doi: 10.1371/journal.pone.0255477. eCollection 2021.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: Netherlands Trial Register, Trial NL5166.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiac Rehabilitation / methods*
  • Cardiovascular Diseases / therapy*
  • Coronary Artery Bypass
  • Exercise Test / methods*
  • Female
  • Heart Valve Prosthesis Implantation
  • Humans
  • Logistic Models
  • Male
  • Oxygen Consumption
  • Percutaneous Coronary Intervention
  • Prognosis
  • Prospective Studies
  • ROC Curve

Associated data

  • NTR/NL5166

Grants and funding

For the Swiss consortium partner (TM, PE, MW), funding was received by the Swiss State Secretariat for Education, Research and Innovation under contract number 15.0139. All other authors received funding by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634439. The funder provided support in the form of salaries for authors [TM, PE, LP, EK, WB, AvV], but had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. None of the commercial partners who provided financial support to any of the coauthors had any role in the perception, conduction, analysis, interpretation nor dissemination of this study.