Clinical Utility of the Cardiorespiratory Optimal Point in Patients with Heart Failure

• Published in: Medicine and science in sports and exercise 2023-10, Vol.55 (10), p.1727-1734
• Main Authors: Kroesen, Sophie H., Bakker, Esmée A., Snoek, Johan A., van Kimmenade, Roland R. J., Molinger, Jeroen, Araújo, Claudio G., Hopman, Maria T.E., Eijsvogels, Thijs M.H.
• Format: Article
• Language: English
• Subjects: Clinical Sciences
• ISSN: 0195-9131; 1530-0315; 1530-0315
• DOI: 10.1249/MSS.0000000000003206

We assessed the cardiorespiratory optimal point (COP) - the minimal VE/VO2 in a given minute of an incremental cardiopulmonary exercise test - in patients with heart failure (HF) and aimed to determine 1) its association with patient and disease characteristics, 2) changes following an exercise-based cardiac rehabilitation program (CR), and 3) the association with clinical outcomes. We studied 277 HF patients (67 [58-74] years, 30% female, 72% HFrEF) between 2009 and 2018. Patients participated in a 12- to 24-week CR program, and COP was assessed pre- and post-CR. Patient and disease characteristics and clinical outcomes (mortality and cardiovascular-related hospitalization) were extracted from patient files. The incidence of clinical outcomes was compared across COP tertiles (low: 30.7). Median COP was 28.2 [24.9-32.1] and was reached at 51 ± 15% of VO2peak. Lower age, female sex, higher body mass index, the absence of a pacemaker or the absence of chronic obstructive pulmonary disease and lower NT-proBNP concentrations were associated with a lower COP. Participation in CR reduced COP (-0.8, 95% confidence interval (CI): -1.3; -0.3). Low COP had a reduced risk (adjusted hazard ratio 0.53, 95%CI 0.33; 0.84) for adverse clinical outcomes as compared to high COP. Classic cardiovascular risk factors are associated with a higher, more unfavorable, COP. CR-based exercise training reduces COP, while a lower COP is associated with a better clinical prognosis. As COP can be established during a submaximal exercise test, this may offer novel risk stratification possibilities for HF care programs.