Pulmonary Hypertension And Exercise Intolerance: A Novel Use Of Cardiomems To Measure Hemodynamic Changes In Exercise
HFSA ePoster Library. Cheng A. 09/10/21; 343532; 294
Andrew Cheng
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Abstract
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Background: Prognostic value of cardiopulmonary exercise test (CPET) in heart failure with reduced ejection fraction is well established, but it's utility in wild type transthyretin cardiac amyloidosis (wtATTR) patients treated with Tafamidis is unknown. Objective: To determine the role of baseline CPET in Tafamidis treated wtATTR amyloid patients. Methods: A retrospective study was conducted to identify wtATTR patients who were treated with Tafamidis and underwent baseline CPET at The University of Kansas Amyloid Clinic from 8/31/2018 until 3/31/2020. Univariate and multivariate logistic regression models were used to predict the occurrence of the primary outcome (composite of mortality, heart transplant, and palliative inotrope initiation).
Results: A total of 33 patients were included with a mean age of 81 ± 5.7 years. About 84% were Caucasians and 79% were males. Mean peak oxygen consumption (VO2) and peak circulatory power (CP) were low at 11.88 ± 3.74 ml/kg/min and 1667.8 ± 804.2 mmHg/ml/min, respectively. Mean VE/VCO2 (Ventilatory efficiency) was 36.65 ± 8.7. After 1 year follow-up, 11 patients had reached the primary outcome. Median exercise duration was significantly lower in patients with primary outcomes compared to those without as shown in figure 1 [4.4 (IQR 3.6-4.7) vs 6.9 (IQR 5.9-8.9), p <0.001]. Upon multivariate analysis; peak VO2 [OR 0.25, CI(0.07-0.91), p=0.03], peak CP [OR 0.99,CI(0.98-0.99), p=0.03] and peak VO2/HR (Oxygen pulse) [OR 0.44, CI(0.22-0.87), p=0.02] were significantly associated with the primary outcome. VE/VC02 (Ventilatory efficiency) was not significantly associated with the primary outcome. (Table 1)
Conclusion: Peak V02, peak CP, and peak VO2/HR may have a prognostic role in selecting which wtATTR patients will benefit from Tafamidis treatment.
Results: A total of 33 patients were included with a mean age of 81 ± 5.7 years. About 84% were Caucasians and 79% were males. Mean peak oxygen consumption (VO2) and peak circulatory power (CP) were low at 11.88 ± 3.74 ml/kg/min and 1667.8 ± 804.2 mmHg/ml/min, respectively. Mean VE/VCO2 (Ventilatory efficiency) was 36.65 ± 8.7. After 1 year follow-up, 11 patients had reached the primary outcome. Median exercise duration was significantly lower in patients with primary outcomes compared to those without as shown in figure 1 [4.4 (IQR 3.6-4.7) vs 6.9 (IQR 5.9-8.9), p <0.001]. Upon multivariate analysis; peak VO2 [OR 0.25, CI(0.07-0.91), p=0.03], peak CP [OR 0.99,CI(0.98-0.99), p=0.03] and peak VO2/HR (Oxygen pulse) [OR 0.44, CI(0.22-0.87), p=0.02] were significantly associated with the primary outcome. VE/VC02 (Ventilatory efficiency) was not significantly associated with the primary outcome. (Table 1)
Conclusion: Peak V02, peak CP, and peak VO2/HR may have a prognostic role in selecting which wtATTR patients will benefit from Tafamidis treatment.
| Variables | Primary outcome | |
| OR (95% CI) | P-value | |
| Baseline CPET parameters | 0.95 (0.91-1.01) | 0.062 |
| Peak systolic BP, mmHg | 0.95 (0.91-1.01) | 0.062 |
| Peak Heart rate, beat/min | 1.02 (0.96-1.07) | 0.587 |
| Peak VO2, ml/kg/min | 0.25 (0.07-0.91) | 0.035 |
| Peak circulatory power | 0.99 (0.98-0.99) | 0.036 |
| VE/VC02 slope | 1.04 (0.93-1.16) | 0.486 |
| VO2AT, ml/kg/min | 0.92 (0.45-1.89) | 0.827 |
| Anaerobic threshold, % | 1.01 (0.84-1.19) | 0.988 |
| PETCO2, mmHg | 0.78 (0.58-1.04) | 0.096 |
| Peak VO2/HR, ml/bpm | 0.44 (0.22-0.87) | 0.019 |
| Chronotopic incompetence | 0.22 (0.19-2.58) | 0.229 |
Background: Prognostic value of cardiopulmonary exercise test (CPET) in heart failure with reduced ejection fraction is well established, but it's utility in wild type transthyretin cardiac amyloidosis (wtATTR) patients treated with Tafamidis is unknown. Objective: To determine the role of baseline CPET in Tafamidis treated wtATTR amyloid patients. Methods: A retrospective study was conducted to identify wtATTR patients who were treated with Tafamidis and underwent baseline CPET at The University of Kansas Amyloid Clinic from 8/31/2018 until 3/31/2020. Univariate and multivariate logistic regression models were used to predict the occurrence of the primary outcome (composite of mortality, heart transplant, and palliative inotrope initiation).
Results: A total of 33 patients were included with a mean age of 81 ± 5.7 years. About 84% were Caucasians and 79% were males. Mean peak oxygen consumption (VO2) and peak circulatory power (CP) were low at 11.88 ± 3.74 ml/kg/min and 1667.8 ± 804.2 mmHg/ml/min, respectively. Mean VE/VCO2 (Ventilatory efficiency) was 36.65 ± 8.7. After 1 year follow-up, 11 patients had reached the primary outcome. Median exercise duration was significantly lower in patients with primary outcomes compared to those without as shown in figure 1 [4.4 (IQR 3.6-4.7) vs 6.9 (IQR 5.9-8.9), p <0.001]. Upon multivariate analysis; peak VO2 [OR 0.25, CI(0.07-0.91), p=0.03], peak CP [OR 0.99,CI(0.98-0.99), p=0.03] and peak VO2/HR (Oxygen pulse) [OR 0.44, CI(0.22-0.87), p=0.02] were significantly associated with the primary outcome. VE/VC02 (Ventilatory efficiency) was not significantly associated with the primary outcome. (Table 1)
Conclusion: Peak V02, peak CP, and peak VO2/HR may have a prognostic role in selecting which wtATTR patients will benefit from Tafamidis treatment.
Results: A total of 33 patients were included with a mean age of 81 ± 5.7 years. About 84% were Caucasians and 79% were males. Mean peak oxygen consumption (VO2) and peak circulatory power (CP) were low at 11.88 ± 3.74 ml/kg/min and 1667.8 ± 804.2 mmHg/ml/min, respectively. Mean VE/VCO2 (Ventilatory efficiency) was 36.65 ± 8.7. After 1 year follow-up, 11 patients had reached the primary outcome. Median exercise duration was significantly lower in patients with primary outcomes compared to those without as shown in figure 1 [4.4 (IQR 3.6-4.7) vs 6.9 (IQR 5.9-8.9), p <0.001]. Upon multivariate analysis; peak VO2 [OR 0.25, CI(0.07-0.91), p=0.03], peak CP [OR 0.99,CI(0.98-0.99), p=0.03] and peak VO2/HR (Oxygen pulse) [OR 0.44, CI(0.22-0.87), p=0.02] were significantly associated with the primary outcome. VE/VC02 (Ventilatory efficiency) was not significantly associated with the primary outcome. (Table 1)
Conclusion: Peak V02, peak CP, and peak VO2/HR may have a prognostic role in selecting which wtATTR patients will benefit from Tafamidis treatment.
| Variables | Primary outcome | |
| OR (95% CI) | P-value | |
| Baseline CPET parameters | 0.95 (0.91-1.01) | 0.062 |
| Peak systolic BP, mmHg | 0.95 (0.91-1.01) | 0.062 |
| Peak Heart rate, beat/min | 1.02 (0.96-1.07) | 0.587 |
| Peak VO2, ml/kg/min | 0.25 (0.07-0.91) | 0.035 |
| Peak circulatory power | 0.99 (0.98-0.99) | 0.036 |
| VE/VC02 slope | 1.04 (0.93-1.16) | 0.486 |
| VO2AT, ml/kg/min | 0.92 (0.45-1.89) | 0.827 |
| Anaerobic threshold, % | 1.01 (0.84-1.19) | 0.988 |
| PETCO2, mmHg | 0.78 (0.58-1.04) | 0.096 |
| Peak VO2/HR, ml/bpm | 0.44 (0.22-0.87) | 0.019 |
| Chronotopic incompetence | 0.22 (0.19-2.58) | 0.229 |
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