Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair

Grant, Stuart W; Hickey, Graeme L.; Wisely, N. A.; Carlson, Eric D.; Hartley, Ronald; Pichel, Adam; Atkinson, D. E.; McCollum, Charles

doi:10.1093/bja/aeu383

Cited by 92 publications

(69 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18-21 Surgical procedures in which CPX has demonstrated prognostic value include abdominal aortic aneurysm repair, [22][23][24][25] radical cystectomy, 26 liver transplantation, 27 hepatic resection, 28 lung resection, [29][30][31][32][33] bariatric surgery, 34,35 and colorectal surgery. 36,37 In fact, the American College of Chest Physicians clinical practice guidelines for evaluation procedures of patients with lung cancer being considered for surgical resection recommend the use of CPX to assess risk.…”

Section: Cpx To Assess Perisurgical and Postsurgical Risk And Long-tementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

View full text Add to dashboard Cite

Abstract-In the past several decades, cardiopulmonary exercise testing (CPX) has seen an exponential increase in its evidence base. The growing volume of evidence in support of CPX has precipitated the release of numerous scientific statements by societies and associations. In 2012, the European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association developed a joint document with the primary intent of redefining CPX analysis and reporting in a way that would streamline test interpretation and increase clinical application. Specifically, the 2012 joint scientific statement on CPX conceptualized an easy-to-use, clinically meaningful analysis based on evidence-vetted variables in color-coded algorithms; single-page algorithms were successfully developed for each proposed test indication. Because of an abundance of new CPX research in recent years and a reassessment of the current algorithms in light of the body of evidence, a focused update to the 2012 scientific statement is now warranted. The purposes of this update are to confirm algorithms included in the initial scientific statement not requiring revision, to propose revisions to algorithms included in the initial scientific statement, to propose new algorithms based on emerging scientific evidence, to further clarify the application of oxygen consumption at ventilatory threshold, to describe CPX variables with an emerging scientific evidence base, to describe the synergistic value of combining CPX with other assessments, to discuss personnel considerations for CPX laboratories, and to provide recommendations for future CPX research. (Circulation. 2016;133:e694-e711.

show abstract

Section: Cpx To Assess Perisurgical and Postsurgical Risk And Long-tementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

View full text Add to dashboard Cite

show abstract

“…It is generally an asymptomatic condition until aneurysm rupture occurs, precipitating sudden collapse or death (Waton et al, 2013). Due to the high mortality associated with emergency surgery, elective repair is the preferred option when AAA size breeches 5.5 cm and surgical outcome can be influenced by a patient's pre-operative cardiorespiratory fitness (Prentis et al, 2012; Grant et al, 2015). Fortunately, fitness is a modifiable factor during the pre-operative phase—if there is a cause and effect relationship with the post-operative course, patients undergoing major abdominal and thoracic surgery will benefit from pre-operative interventions to improve their fitness (Hoogeboom et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Patients Awaiting Surgical Repair for Large Abdominal Aortic Aneurysms Can Exercise at Moderate to Hard Intensities with a Low Risk of Adverse Events

et al. 2017

View full text Add to dashboard Cite

Purpose: Intervention fidelity refers to the extent an experimental manipulation has been implemented as intended. Our aim was to evaluate the fidelity of high-intensity interval training (HIT) in patients awaiting repair of large abdominal aortic aneurysms.Methods: Following a baseline cardiopulmonary exercise test, 27 participants performed a hospital-based, supervised HIT intervention in the 4 weeks preceding surgery. The intervention was performed thrice weekly on a cycle ergometer and involved either 8 × 2-min intervals, each interspersed by 2-min recovery periods, or 4 × 4-min intervals interspersed with 4-min recovery periods. When surgery was delayed, participants undertook one maintenance HIT session per week until surgery. Session one power output was set to baseline anaerobic threshold power output and then increased on subsequent sessions until ratings of perceived exertion (RPE; Borg CR-10) for the legs (RPE-L) and sense of breathlessness/ chest (RPE-C) were hard (5) to very hard (7) at the end of each interval. For safety, power output was maintained or reduced if systolic blood pressure exceeded 180 mm Hg or heart rate exceeded 95% of maximum.Results: Overall session attendance across the 4-week HIT intervention was 74%. Seventeen participants met our compliance criteria of ≥75% of intervention sessions and all maintenance sessions. When compared to non-compliance, compliant participants had higher fitness, performed more HIT sessions and were able to exercise at higher exercise intensities with a lower proportion of exercise safety breaches. In the 17 compliant participants, the proportion of repetitions meeting the HIT criterion was 30% (RPE-L) and 16% (RPE-C). Mean repetition intensity was 4.1 ± 2.0 Arbitrary Units [AU] (RPE-L) and 3.5 ± 1.9 AU (RPE-C) with a within-subject variability of ±1.4 AU and ±1.6 AU, respectively. We observed higher RPE scores (~0.5 AU) following 2-min intervals when compared to 4-min intervals and exercise power output increased 23% across the 4-week HIT intervention. One participant experienced an adverse event but were still able to complete their remaining exercise sessions.Conclusions: Despite an inconsistent and lower than prescribed intensity, it is possible to exercise this high-risk patient population at moderate to hard intensities with a low risk of adverse events.Clinical Trial Registration: http://www.isrctn.com/, registration number ISRCTN09433624.

show abstract

“…Previous studies assessing variation in the VT between experienced readers similarly showed roughly 20% interobserver variability, 17-25% intra-observer variability, and 21% variability between centres. 19,39 In practical terms, this degree of variability is potentially significant when considering outcomes in perioperative assessments. 5,11,13,15,22,[39][40][41] In two recent reviews, Levett et al 5,12 summarized studies assessing the association between preoperative VT and postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…19,39 In practical terms, this degree of variability is potentially significant when considering outcomes in perioperative assessments. 5,11,13,15,22,[39][40][41] In two recent reviews, Levett et al 5,12 summarized studies assessing the association between preoperative VT and postoperative outcomes. These studies among different surgery candidates (including major intra-abdominal, colon, rectal, hepatobiliary, hepatic resection, liver transplant, upper gastrointestinal, bariatric, cystectomy, and AAA repair procedures) showed that values below 9-12 mLO 2 Ákg -1…”

Section: Discussionmentioning

confidence: 99%

Comparaison des méthodes de détermination des seuils ventilatoires: implications pour la stratification du risque chirurgical

Vainshelboim

Rao

Chan

et al. 2017

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose The ventilatory threshold (VT) is an objective physiological marker of the capacity of aerobic endurance that has good prognostic applications in preoperative settings. Nevertheless, determining the VT can be challenging due to physiological and methodological issues, especially in evaluating surgical risk. The purpose of the current study was to compare different methods of determining VT and to highlight the implications for assessing perioperative risk. Methods Our study entailed analysis of 445 treadmill cardiopulmonary exercise tests from 140 presurgical candidates with an aortic abdominal aneurysm (C3.0 to B5.0 cm) and a mean (standard deviation [SD]) age of 72 (8) yr. We used three methods to determine the VT in 328 comparable tests, namely, self-detected metabolic system (MS), experts' visual (V) readings, and software using a log-log transformation (LLT) of ventilation vs oxygen uptake. Differences and agreement between the three methods were assessed using analysis of variance (ANOVA), coefficient of variation (CV), typical error limits of agreement (LoA), and interclass correlation coefficients (ICC).Results Overall, ANOVA revealed significant differences between the methods [MS = 14.1 (4.3) mLO 2 Ákg -1 Ámin-1 ; V = 14.6 (4.4) mLO 2 Ákg -1 Ámin -1 ; and LLT = 12.3 (3.3) mLO 2 Ákg -1 Ámin -1 ; P \ 0.001]. The assessment of agreement between methods provided the following results: ICC = 0.85; 95% confidence interval (CI), 0.82 to 0.87; P \ 0.001; typical error, 2.1-2.8 mLO 2 Ákg -1 Ámin -1 ; and, 95% LoA and CV ranged from 43 to 55% and 15.9 to 19.6%, respectively. Conclusions The results show clinically significant variations between the methods and underscore the challenges of determining VT for perioperative risk stratification. The findings highlight the importance of meticulous evaluation of VT for predicting surgical outcomes. Future studies should address the prognostic perioperative utility of computed mathematical models combined with an expert's review. This trial was registered at ClinicalTrials.gov, identifier: NCT00349947.

show abstract

Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair

Abstract: CPET variables are independent predictors of reduced survival after elective AAA repair and can identify a cohort of patients with reduced survival at 3 years post-procedure. CPET is a potentially useful adjunct for clinical decision-making in patients with AAA.

Cited by 92 publications

References 36 publications

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

Patients Awaiting Surgical Repair for Large Abdominal Aortic Aneurysms Can Exercise at Moderate to Hard Intensities with a Low Risk of Adverse Events

Comparaison des méthodes de détermination des seuils ventilatoires: implications pour la stratification du risque chirurgical

Contact Info

Product

Resources

About