Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial

Abstract

Aims Oxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. The aim of this analysis was to examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome and to determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI). Methods and results Patients with severe single-vessel coronary artery disease (CAD) were randomized 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomization treadmill CPET, dobutamine stress echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period. A total of 195 patients with CPET data were randomized (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score [+0.82 segments; 95% confidence interval (CI): 0.40 to 1.25, P = 0.0068] and lower fractional flow reserve (−0.07; 95% CI: −0.12 to −0.02, P = 0.011) compared with those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score [oxygen-pulse plateau presence (Pinteraction = 0.026) and oxygen-pulse gradient (Pinteraction = 0.023)] and Seattle angina physical-limitation score [oxygen-pulse plateau presence (Pinteraction = 0.037)]. Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse, and oxygen uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI. Conclusion Although selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel CAD.

The association between O2-pulse slope ratio and functional severity of coronary stenosis: A combined cardiopulmonary exercise testing and quantitative flow ratio study

“…However, in the present study, other traditional ischemia indicators derived from CPET, such as peak VO 2 /kg, peak VO 2 /HR, and peak ΔVO 2 /ΔWR, were not associated with the functional severity of coronary stenosis. This contrasts with previously reported studies but aligns with the findings of the ORBITAL trial [26] . This discrepancies in these results may be partially attributed to the diverse functional assessments employed across different studies [33] , [34] .…”

“…To quantitatively assess the trajectory of the O 2 -pulse curve, we segmented it into early and late stages. We then calculated the slope changes within these two stages, as described in previous studies [26] , [27] . As shown in Fig.…”

Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

“…O platô do PO 2 foi a única variável capaz de detectar a gravidade da isquemia e predizer a eficácia da ICP na DIC grave de único vaso. 101 Trabalhos recentes avaliaram o papel do TCPE na disfunção microvascular coronariana, particularmente em mulheres, onde o TE tem menor acurácia. Estudo em mulheres na pós-menopausa, com angina típica e sem doença arterial coronariana obstrutiva à angiografia, demonstrou que a isquemia à cintilografia estava associada a disfunção sistólica do VE após o estresse, sugerindo DIC microvascular.…”

Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: A comparison of subjective and novel objective methodology

“…Cardiopulmonary exercise testing (CPET) allows for the non-invasive, objective quantification of cardiopulmonary fitness, and is thus held as the 'gold standard' methodology for evaluating functional capacity [1,2]. In contrast to more traditional assessments, such as ECG stress testing and the 6-minute walk test, CPET makes it possible to determine the potential pathophysiological mechanisms underlying exercise intolerance [2][3][4].…”

“…The utility of CPET as a diagnostic and prognostic tool in the evaluation of patients with coronary artery disease (CAD) and heart failure has received some attention [1][2][3][4][5]. In particular, an early plateau or inflection in the normal linear progression of oxygen pulse (O 2 Pulse) and oxygen consumption (VO 2 ) despite an increasing work-rate (WR) are suggested to be indicative of inducible and reversable ischaemia [2,4,[6][7][8][9]. In principle, O 2 Pulse reflects left ventricular stroke volume (SV) (and arteriovenous oxygen difference) [1,4].…”