Key result
In patients treated for acute myocardial infarction with normal or mildly reduced ejection fraction, peak arteriovenous oxygen difference was the strongest independent predictor of exercise capacity (β = 93.5, p < 0.001).
Why the study?
Exercise capacity after acute myocardial infarction influences prognosis, but the causes of its reduction are complex and not sufficiently studied.
Does combined stress echocardiography and cardiopulmonary exercise testing identify predictors of exercise capacity in patients after acute myocardial infarction with normal or mildly reduced LVEF?
Cross-Sectional (n=81)
No
Does combined stress echocardiography and cardiopulmonary exercise testing identify predictors of exercise capacity in patients after acute myocardial infarction with normal or mildly reduced LVEF?
Effect estimate: β = 93.5 (95% CI 77.9-109.1)
p-value: p=<0.001
In patients treated for AMI with normal or mildly reduced LVEF, exercise capacity is strongly associated with peak peripheral oxygen extraction, highlighting the importance of peripheral factors in exercise intolerance.
CPET-SE may clarify mechanisms of reduced exercise capacity post-AMI; leaves open its value for risk stratification or therapy guidance.
Background Exercise capacity (EC) after acute myocardial infarction (AMI) influences prognosis, but the causes of its reduction are complex and not sufficiently studied. Methods We prospectively enrolled consecutive patients who underwent percutaneous coronary intervention for their first AMI with left ventricular ejection fraction (LV EF) >40% at least 4 weeks after AMI. We performed combined stress echocardiography and cardiopulmonary exercise testing (CPET-SE) using a semi-supine cycle ergometer to determine predictors of EC (peak oxygen uptake [VO2]). Results Among 81 patients (70% male, mean age 58 ± 11 years), 40% had AMI with ST-segment elevation, and 60% non ST-segment elevation, LV EF was 57 ± 7%; wall motion score index, 1.18 (IQR 1.06 – 1.31); peak VO2, 19.5 ± 5.4 mL/kg/min. Multivariate analysis revealed that parameters at peak exercise: heart rate (β = 0.17, p < 0.001), stroke volume (β = 0.09, p < 0.001), and arteriovenous oxygen difference (A-VO2Diff, β = 93.51, p < 0.001) were independently positively correlated with peak VO2, with A-VO2Diff being its strongest contributor. Conclusions In patients treated for AMI with normal/mildly reduced LV EF, EC is associated with peak peripheral oxygen extraction as well as peak heart rate and peak stroke volume. CPET-SE is a useful tool to evaluate decreased fitness in this group.
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Smarż et al. (2020) conducted a cross-sectional in Acute Myocardial Infarction (n=81). Peak arteriovenous oxygen difference (A-VO2Diff) was evaluated on Peak oxygen uptake (VO2) (β = 93.5, 95% CI 77.9-109.1, p=<0.001). In patients treated for acute myocardial infarction with normal or mildly reduced ejection fraction, peak arteriovenous oxygen difference was the strongest independent predictor of exercise capacity (β = 93.5, p < 0.001).
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