@misc{10481/85920,
year = {2023},
month = {10},
url = {https://hdl.handle.net/10481/85920},
abstract = {Introduction 

We assessed the cardiorespiratory optimal point (COP)—the minimal V̇E/V̇O2 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 after an exercise-based cardiac rehabilitation program (CR), and 3) the association with clinical outcomes.
Methods 

We studied 277 HF patients (67 (58–74) yr, 30% female, 72% HF with restricted ejection fraction) between 2009 and 2018. Patients participated in a 12- to 24-wk 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, <26.0; moderate, 26.0–30.7; high, >30.7).
Results 

Median COP was 28.2 (24.9–32.1) and was reached at 51% ± 15% of V̇O2peak. Lower age, female sex, higher body mass index, the absence of a pacemaker or the absence of chronic obstructive pulmonary disease, and lower N-terminal prohormone brain natriuretic peptide concentrations were associated with a lower COP. Participation in CR reduced COP (−0.8; 95% confidence interval, −1.3 to −0.3). Low COP had a reduced risk (adjusted hazard ratio, 0.53; 95% confidence interval, 0.33–0.84) for adverse clinical outcomes as compared with high COP.
Conclusions 

Classic cardiovascular risk factors are associated with a higher, more unfavorable, COP. CR-based exercise training reduces COP, whereas 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.},
organization = {Eurostars Grant (E!114585)},
publisher = {Wolters Kluwer Health},
keywords = {Cardiopulmonary exercise testing},
keywords = {Cardiac rehabilitation},
keywords = {Ventilatory efficiency},
keywords = {Cardiovascular Risk},
keywords = {Physical fitness},
title = {Clinical Utility of the Cardiorespiratory Optimal Point in Patients with Heart Failure},
doi = {10.1249/MSS.0000000000003206},
author = {Kroesen, Sophie H. and Bakker, Esmée A.},
}