Calculated versus Measured MVV—Surrogate Marker of Ventilatory Capacity in Pediatric CPET

Colwell, Kelly L; Bhatia, Rajeev

doi:10.1249/mss.0000000000001318

Cited by 12 publications

(15 citation statements)

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“…Her MVV estimated by Kennedy equation (1953) would be increased by 15.38 L/min (3.56 times 40 vs. 3.56 times 35.68), that is, 12%. Such an increase would reduce the diagnostic potential of CPET with an imprecise determination of ventilatory limitation defined as ventilatory reserve < 20% MVV (Colwell & Bhatia, 2017). An overestimation of MVV value would thus lead to an erroneous exclusion of a diagnosis of ventilatory limitation in individuals.…”

Section: T a B L E 2 Correlation Between Spirometric Parameters And Amentioning

confidence: 99%

“…In practice, the MVV is measured over 12 s and then extrapolated to one minute to overcome the difficulties (shortness of breath, fatigue, dizziness) that a subject may encounter during the measurement process, which can often be tedious and time‐consuming (Colwell & Bhatia, 2017; Kennedy, 1953). Better still, these difficulties led several authors to develop and use an equation to estimate its value based on maximum volume of air exhaled during the first second of forced expiration (FEVı) following maximum inspiration: MVV = FEVı × 35 (Gandevia & Hugh‐Jones, 1957) FEVı × 37.5 (Cara, 1953) or MVV = FEVı × 40 (Kennedy, 1953) are among the most common in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…For more than half a century, several authors have been using the constant MVV/FEVı ratio to estimate MVV in any population (Anderson et al., 2001; Colwell & Bhatia, 2017; Wasserman et al., 1987). For example, the Medical Commission of the International Olympic Committee, in its fight against doping in sport, recommends bronchial provocation by eucapnic voluntary hyperventilation (EVH), considered to be the gold standard for diagnosing exercise‐induced bronchoconstriction (EIB).…”

Section: Introductionmentioning

confidence: 99%

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Gender influence on the MVV / FEVı ratio in a population of healthy young adults

et al. 2020

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Introduction Maximal voluntary ventilation (MVV) and flow expiratory volume in the first second (FEVı) are important spirometric parameters. They are both gender‐dependent. However, estimating the MVV, which is widely practiced in cardiopulmonary function testing, by multiplying FEVı by a constant value (equal to MVV/FEVı ratio) does not seem to take this into account. The purpose of this study was to compare the MVV/FEVı ratio by gender among healthy young adults. Methods This cross‐sectional prospective study involved 67 medical sciences students, including 36 females of the same race, height, and age group. Their ventilatory function was assessed using a computerized spirometer, according to international recommendations. Pearson's test made it possible to correlate different spirometric parameters and linear regression was established between MVV and FEVı. The nonparametric Kruskal–Wallis test was used to compare the MVV/FEVı ratio between females and males. Comparisons by gender were made also between our data and previous prediction equations. Results In both females and males, FEVı was the spirometric parameter with which MVV had the highest correlation ( r = .91 in females, r = .63 in males). A comparison of the means of the MVV/FEVı ratio by gender showed a statistically significant ( p < .005) decrease in females (35.68 vs. 38.87). The previous prediction equations showed statistically significant under and overestimation of MVV values when gender was not taken into account. Conclusion For the same height, age, and race, the ratio MVV/FEVı was significantly lower for females. So, the use of a preset constant value in estimating the MVV without taking gender into account was methodologically questionable. This work, which could have clinical implications, would benefit from being confirmed in a larger population.

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Section: T a B L E 2 Correlation Between Spirometric Parameters And Amentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gender influence on the MVV / FEVı ratio in a population of healthy young adults

et al. 2020

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“…The maximal voluntary ventilation (MVV) is the largest amount of air that a person can inhale and then exhale during a 12to 15-s interval with maximal voluntary effort (Neder et al, 1999). This maneuver was used to provide information about the functioning of the inspiratory pump and chest wall and is used to evaluate maximum ventilatory capacity (Colwell and Bhatia, 2017) and respiratory muscle endurance, but the last ERS statement on respiratory muscle tests does not recommend its use for these purposes because mechanical aspects of the chest wall and lung tissue can affect the MVV value (Laveneziana et al, 2019). It is used for indirect calculation of the ventilatory reserve through a relationship with minute volume during a maximum exercise test (ATS/ACCP, 2003).…”

Section: Introductionmentioning

confidence: 99%

Maximal Voluntary Ventilation Should Not Be Estimated From the Forced Expiratory Volume in the First Second in Healthy People and COPD Patients

et al. 2020

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Purpose: To evaluate the concordance between the value of the actual maximum voluntary ventilation (MVV) and the estimated value by multiplying the forced expiratory volume in the first second (FEV 1 ) and a different value established in the literature.Methods: A retrospective study was conducted with healthy subjects and patients with stable chronic obstructive pulmonary disease (COPD). Five prediction formulas MVV were used for the comparison with the MVV values. Agreement between MVV measured and MVV obtained from five prediction equations were studied. FEV 1 values were used to estimate MVV. Correlation and agreement analysis of the values was performed in two groups using the Pearson test and the Bland-Altman method; these groups were one group with 207 healthy subjects and the second group with 83 patients diagnosed with COPD, respectively.Results: We recruited 207 healthy subjects (105 women, age 47 ± 17 years) and 83 COPD patients (age 66 ± 6 years; 29 GOLD II, 30 GOLD III, and 24 GOLD IV) for the study. All prediction equations presented a significant correlation with the MVV value (from 0.38 to 0.86, p < 0.05) except for the GOLD II subgroup, which had a poor agreement with measured MVV. In healthy subjects, the mean difference of the value of bias (and limits of agreement) varied between -3.9% (-32.8 to 24.9%), and 27% (-1.4 to 55.3%). In COPD patients, the mean difference of value of bias (and limits of agreement) varied between -4.4% (-49.4 to 40.6%), and 26.3% (-18.3 to 70.9%). The results were similar in the subgroup analysis.

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“…Specifically, Fulton et al (1995) found that MVV was similar to the proxy measure of MVV viz 35⋅FEV 1 in healthy African–American, adolescent girls. Furthermore, a recent study found that conclusions from test results depend on which surrogate for MVV is chosen only compounds interpretation challenges (Colwell and Bhatia, 2017). Taken together, it is not at all clear whether directly measured MVV or multiples of FEV 1 as proxies for MVV reflect EFL and therefore ventilatory limitation during exercise in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

Ventilatory Limitation of Exercise in Pediatric Subjects Evaluated for Exertional Dyspnea

Pianosi

Smith

2019

Front. Physiol.

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Purpose: Attribution of ventilatory limitation to exercise when the ratio of ventilation (trueV˙E) at peak work to maximum voluntary ventilation (MVV) exceeds 0.80 is problematic in pediatrics. Instead, expiratory flow limitation (EFL) measured by tidal flow-volume loop (FVL) analysis – the method of choice – was compared with directly measured MVV or proxies to determine ventilatory limitation.Methods: Subjects undergoing clinical evaluation for exertional dyspnea performed maximal exercise testing with measurement of tidal FVL. EFL was defined when exercise tidal FVL overlapped at least 5% of the maximal expiratory flow-volume envelope for > 5 breaths in any stage of exercise. We compared this method of ventilatory limitation to traditional methods based on MVV or multiples (30, 35, or 40) of FEV1. Receiver operating characteristic curves were constructed and area under curve (AUC) computed for peak trueV˙E/MVV and peak trueV˙E/x⋅FEV1.Results: Among 148 subjects aged 7–18 years (60% female), EFL was found in 87 (59%). Using EFL shown by FVL analysis as a true positive to determine ventilatory limitation, AUC for peak trueV˙E/30⋅FEV1 was 0.84 (95% CI 0.78–0.90), significantly better than AUC 0.70 (95% CI 0.61–0.79) when 12-s sprint MVV was used for peak trueV˙E/MVV. Sensitivity and specificity were 0.82 and 0.70 respectively when using a cutoff of 0.85 for peak trueV˙E/30⋅FEV1 to predict ventilatory limitation to exercise.Conclusion: Peak trueV˙E/30⋅FEV1 is superior to peak trueV˙E/MVV, as a means to identify potential ventilatory limitation in pediatric subjects when FVL analysis is not available.

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Calculated versus Measured MVV—Surrogate Marker of Ventilatory Capacity in Pediatric CPET

Abstract: The measured MVV was significantly lower than the calculated MVV in our pediatric subjects. The calculated MVV was a better surrogate of maximum ventilatory capacity as shown by significant correlation to other ventilatory parameters during CPET.

Cited by 12 publications

References 12 publications

Gender influence on the MVV / FEVı ratio in a population of healthy young adults

Gender influence on the MVV / FEVı ratio in a population of healthy young adults

Maximal Voluntary Ventilation Should Not Be Estimated From the Forced Expiratory Volume in the First Second in Healthy People and COPD Patients

Ventilatory Limitation of Exercise in Pediatric Subjects Evaluated for Exertional Dyspnea

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