Prognostic value of aerobic capacity and exercise oxygen pulse in postaortic dissection patients.

Delsart P; Delahaye C; Devos P; Domanski O; Azzaoui R; Sobocinski J; Juthier F; Vincentelli A; Rousse N; Mugnier A; Soquet J; Loobuyck V; Koussa M; Modine T; Jegou B; Bical A; Hysi I; Fabre O; Pontana F; Matran R; Mounier-Vehier C; Montaigne D;

Clinical Cardiology. 44(2):252-260, 2021 Feb.

BACKGROUND: Although recommendations encourage daily moderate activities
in post aortic dissection, very little data exists regarding
cardiopulmonary exercise testing (CPET) to personalize those patient’s
physical rehabilitation and assess their cardiovascular prognosis.

DESIGN: We aimed at testing the prognostic insight of CPET regarding
aortic and cardiovascular events by exploring a prospective cohort of
patients followed-up after acute aortic dissection.

METHODS: Patients referred to our department after an acute (type A or B)
aortic dissection were prospectively included in a cohort between
September 2012 and October 2017. CPET was performed once optimal blood
pressure control was obtained. Clinical follow-up was done after CPET for
new aortic event and major cardio-vascular events (MCE) not directly
related to the aorta.

RESULTS: Among the 165 patients who underwent CPET, no adverse event was
observed during exercise testing. Peak oxygen pulse was 1.46(1.22-1.84)
mlO2/beat, that is, 97 (83-113) % of its predicted value, suggesting
cardiac exercise limitation in a population under beta blockers (92% of
the population). During a follow-up of 39(20-51) months from CPET, 42
aortic event recurrences and 22 MCE not related to aorta occurred. Low
peak oxygen pulse (<85% of predicted value) was independently predictive
of aortic event recurrence, while low peak oxygen uptake (<70% of
predicted value) was an independent predictor of MCE occurrence.

CONCLUSION: CPET is safe in postaortic dissection patients should be used
to not only to personalize exercise rehabilitation, but also to identify
those patients with the highest risk for new aortic events and MCE not
directly related to aorta.