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Predictors of low functional capacity in moderate-severe left ventricular systolic dysfunction patients included in a cardiac rehabilitation program.

Session Poster Session 3

Speaker Oscar Gonzalez Fernandez

Event : Heart Failure 2016

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : O Gonzalez Fernandez (Madrid,ES), P Meras Colunga (Madrid,ES), V Rial Baston (Madrid,ES), J Irazusta Cordoba (Madrid,ES), R Dalmau Gonzalez-Gallarza (Madrid,ES), C Alvarez Ortega (Madrid,ES), R Mori Junco (Madrid,ES), I Ponz De Antonio (Madrid,ES), A Castro Conde (Madrid,ES), JL Lopez Sendon (Madrid,ES)

Authors:
O Gonzalez Fernandez1 , P Meras Colunga1 , V Rial Baston1 , J Irazusta Cordoba1 , R Dalmau Gonzalez-Gallarza1 , C Alvarez Ortega1 , R Mori Junco1 , I Ponz De Antonio1 , A Castro Conde1 , JL Lopez Sendon1 , 1University Hospital La Paz, Cardiology - Madrid - Spain ,

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2016 ) 18 ( Supplement 1 ), 406

Introduction: Cardiac rehabilitation programs(CRPs) in left ventricular systolic dysfunction(LVSD) patients(p.) provide optimal medical treatment(OMT), close monitoring, exercise, education and counselling. LVSD has been considered an important predictor of low functional capacity(FC). Our purpose was to describe predictors of low FC in moderate-severe LVSD p. performing a CRP. Methods: We made an observational retrospective study including p. with moderate-severe LVSD admitted to a CRP between 2006 and 2015. Physical training, OMT, medical counselling, education, and smoking cessation support, were supplied for 8 to 10 weeks. Left ventricular ejection fraction(LVEF) was assessed before and after the program using TTE. FC was tested before and after the CRP in accordance with the NYHA Classification, besides a treadmill stress test(TST). Exercise capacity(EC) was reported in METs. Results: A total of 298 p. were included, mean age 58.1 ± 11.2 years, male 89.6%. Baseline characteristics are shown in graphic 1. In most p.(91.2%), cardiac rehabilitation was due to a recent acute coronary syndrome. No statistically significant differences depending on the previous cardiovascular risk factors (CVRF) and comorbidities among moderate(LVEF 30-40%) and severe( < 30%) LVSD p. were found. Medical therapy when starting the program showed a significantly higher use of MRAs, diuretics and anticoagulants in severe than moderate LVSD p.(p = 0.007, p < 0.001, p = 0.032; respectively), with no other differences among them. FC assessed by NYHA class, considering class I vs class II or III p., revealed significant differences in hypertension, diabetes and current smoking. Severe LVSD p. had a higher NYHA class than moderate LVSD p. before(II-III: 74.1% vs 46.4%; p < 0.001) and after the program(41.5% vs 17.3%; p < 0.001). NYHA II or III was associated with a higher prevalence of comorbidities: chronic pulmonary obstructive disease(CPOD), cerebrovascular disease(CD) and peripheral artery disease(PAD). P. who had low EC( < 7 METs) had significantly more CVRF. Severe LVSD p. had a lower EC than moderate LVSD p. before(5.7 ± 2.8 vs 6.9 ± 2.6; p < 0.001) and after the CPR(9.4 ± 2.8 vs 10.4 ± 2.7; p = 0.008). Regarding comorbidities, a worst EC was associated with a higher prevalence of chronic kidney disease, CD and a non-significant trend of CPOD. The dropout rate was superior in p. with low EC(13.9% vs 5.6%; p = 0.027), not depending on NYHA(8.9% vs 10.9%, NS). Conclusions: Severe LVSD p. included in a CRP have a lower FC and EC than moderate LVSD p.. Previous CVRF and comorbidities in moderate and severe LVSD p. associate a lower FC and EC regardless of their LVEF.

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