Article

Peak oxygen uptake is an independent predictor of mortality in
patients with coronary artery disease (CAD). However, patients with CAD are not
always capable of reaching peak effort, and therefore submaximal gas exchange
variables such as the oxygen uptake efficiency slope (OUES) have been introduced.
Baseline exercise capacity as expressed by OUES provides prognostic information
and this parameter responds to training. Therefore, we aimed to assess the
prognostic value of post-training OUES in patients with CAD. METHODS: We included
960 patients with CAD (age 60.6 +/- 9.5 years; 853 males) who completed a cardiac
rehabilitation program between 2000 and 2011. The OUES was calculated before and
after cardiac rehabilitation and information on mortality was obtained. The
relationships of post-training OUES with all-cause and cardiovascular (CV)
mortality was assessed by Cox proportional hazards regression analyses. Receiver
operator characteristic curve analysis was performed in order to obtain the
optimal cut-off value. RESULTS: During 7.37 +/- 3.20 years of follow-up (range:
0.45-13.75 years), 108 patients died, among whom 47 died due to CV reasons. The
post-training OUES was related to all-cause (hazard ratio: 0.50, p < 0.001) and
CV (hazard ratio: 0.40, p < 0.001) mortality. When significant covariates,
including baseline OUES, were entered into the Cox regression analysis,
post-training OUES remained related to all-cause and CV mortality (hazard ratio:
0.40, p < 0.01 and 0.26, p < 0.01, respectively). In addition, the change in OUES
due to exercise training was positively related to mortality (hazard ratio: 0.49,
p < 0.01). CONCLUSION: Post-training OUES has stronger prognostic value compared
to baseline OUES. The lack of improvement in exercise capacity expressed by OUES
after an exercise training program relates to a worse prognosis and can help
distinguish patients with favorable and unfavorable prognoses.
CI - (c) The European Society of Cardiology 2016.

Langue : ANGLAIS