Functional predictors of poor outcomes in Chagas cardiomyopathy: The value of end-tidal carbon dioxide at peak exercise

• Published in: Heart & lung Vol. 62; pp. 152 - 156
• Main Authors: Vianna, Marcus Vinícius Accetta, Ávila, Matheus Ribeiro, Figueiredo, Pedro Henrique Scheidt, Lima, Vanessa Pereira, Carvalho, Liliany Mara Silva, da Cruz Ferreira, Paulo Henrique, de Oliveira, Lucas Fróis Fernandes, Silva, Whesley Tanor, de Almeida, Igor Lucas Geraldo Izalino, Lacerda, Ana Cristina Rodrigues, Mendonça, Vanessa Amaral, de Castro Faria, Sanny Cristina, Mediano, Mauro Felippe Felix, da Costa Rocha, Manoel Otávio, Costa, Henrique Silveira
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2023
• Subjects: Chagas cardiomyopathy; Chagas disease; Exercise testing; Prognosis; NYHA; SBP; Prognosis; VO2peak; CPET; PETCO2 peak; ROC; Chagas disease; LVEF; HRR; LVDd; HR; E/e’ ratio; PETCO2; DBP; VE/VCO2 slope; Exercise testing; RER; Chagas cardiomyopathy; ChC; BMI
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2023.07.010

•PETCO2 peak and VO2peak were lower in chagas cardiomyopathy patients with adverse events.•PETCO2 peak and VO2peak are independent predictors of worse prognosis.•PETCO2 peak and VO2peak lower than 32 mmHg and 20 mL.kg.min identify worse prognosis.
Functional impairment can be detected from the onset of heart disease in patients with Chagas cardiomyopathy (ChC) and the prognostic value of the end-tidal carbon dioxide at peak exercise (PETCO2 peak) should be investigated.
To verify the prognostic value of PETCO2 peak in patients with ChC.
Seventy-six patients with ChC (49.2 ± 9.8 years, NYHA I-III) were evaluated by echocardiography and Cardiopulmonary Exercise Testing. Patients were followed up to four years and the end-point was defined as cardiovascular death, stroke, or cardiac transplantation.
At the end of the follow-up period (29.0 ± 16.0 months), 16 patients (21%) had experienced adverse events. The area under the receiver operating characteristic (ROC) curve to identify the risk of adverse events by PETCO2 peak in patients with ChC was 0.83 (95% CI: 0.69 to 0.97), and the value of 32 mmHg was the optimal cut point (70% of sensitivity and 85% of specificity). In the Kaplan-Meier diagram, there was a significant difference (p<0.001) between patients with reduced (≤ 32 mmHg) and preserved PETCO2 peak (>32 mmHg). In the final Cox multivariate model, only reduced PETCO2 peak (HR 4.435; 95% CI: 1.228 to 16.016, p = 0.023) and VO2peak (HR 0.869; 95% CI: 0.778 to 0.971, p = 0.013) remained as independent predictors of poor outcome in ChC patients.
Reduced PETCO2 peak and VO2peak demonstrated valuable prognostic value in patients with ChC. The cutoff points for both functional variables can be used during risk stratification and may help in the development of therapeutic strategies in ChC patients.