Peak circulatory power <2300 mL/kg/min·mmHg was an independent predictor of mortality in patients entering cardiac rehabilitation (HR 2.985; 95% CI 1.040-8.567; p=0.042).
Cohort (n=479)
Does a low peak circulatory power (<2300 mL/kg/min·mmHg) predict mortality in patients entering a phase II cardiac rehabilitation program?
A low peak circulatory power (<2300 mL/kg/min·mmHg) derived from CPET is an independent predictor of all-cause mortality in patients entering cardiac rehabilitation, regardless of LVEF.
Hazard Ratio: 2.985 (95% CI 1.04–8.567)
p-value: p=0.042
Abstract Background Peak circulatory power (PCP), a CPET-derived index obtained by the product of peak oxygen consumption and peak systolic arterial pressure, has been proposed as a prognostic marker in several heart-failure phenotypes. Whether PCP predicts mortality across the full left-ventricular ejection–fraction (LVEF) spectrum remains insufficiently defined. Aim To investigate the ability of PCP to predict mortality in an unselected population entering a phase II cardiac rehabilitation (CR) program. Methods We retrospectively analyzed patients enrolled in a phase II CR program from 2015 to 2025 who completed CPET prior to initiation. ROC analysis was used to evaluate the discriminative ability of peak PCP and identify an optimal cutoff for mortality prediction. Survival was assessed using Kaplan–Meier curves and Cox proportional-hazards models. Results A total of 479 patients were included (mean age 61 years; 80% male; mean LVEF 50%). Over a mean follow-up of 2.5 years, 20 deaths occurred. Peak PCP demonstrated fair discriminatory power for mortality (AUC 0.64), with an optimal threshold of 2300 mL/kg/min·mmHg, yielding 68% sensitivity and 63% specificity. Patients below this cutoff exhibited significantly higher mortality (log-rank p=0.006). PCP 2300 mL/kg/min·mmHg was associated with increased mortality on univariate analysis (HR 3.350, 95% CI 1.335–8.404, p=0.01) and remained an independent predictor after adjustment age, sex and LVEF (HR 2.985, 95% CI 1.040–8.567, p=0.042). Conclusions In our cohort, PCP is a predictor of all-cause mortality, regardless of LVEF. A low PCP (2300 mL/kg/min·mmHg) identifies individuals at substantially elevated risk, reinforcing its role as a simple, noninvasive CPET-derived metric for prognostic assessment. Larger, prospective studies are warranted to validate these observations and clarify its potential integration into routine risk stratification.For image description, please refer to the figure legend and surrounding text.
Ferreira et al. (Mon,) conducted a cohort in Patients entering a phase II cardiac rehabilitation program (n=479). Peak circulatory power <2300 mL/kg/min·mmHg vs. Peak circulatory power ≥2300 mL/kg/min·mmHg was evaluated on Mortality (HR 2.985, 95% CI 1.040-8.567, p=0.042). Peak circulatory power <2300 mL/kg/min·mmHg was an independent predictor of mortality in patients entering cardiac rehabilitation (HR 2.985; 95% CI 1.040-8.567; p=0.042).