Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection

Kallianos, Anastasios; Rapti, Aggeliki; Tsimpoukis, Sotirios; Charpidou, Andriani; Dannos, Ioannis; Kainis, Elias; Syrigos, Konstantinos

doi:10.1186/1939-4551-8-s1-a22

Cited by 10 publications

(3 citation statements)

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“…Under current guidelines, CPET is recommended only for those patients with lower FEV1, diffusing capacity of the lung for carbon monoxide (DLCO), or their predicted postoperative (ppo) values, that is FEV1 or DLCO <80% predicted by European Respiratory Society/European Society of Thoracic Surgeons ( 18 ), or ppoFEV1 or ppoDLCO <30% by American College of Chest Physician ( 31 ). We thought that even though the spirometric values correlate strongly with the severity of lung obstruction, they can't provide direct information regarding the degree of gas exchange and cardiovascular reserve ( 32 ). On the contrary, CPET reflects interactions between pulmonary function, cardiovascular status and oxygen uptake and utilization by the peripheral tissues ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Chao

Tuan²,

Tang³

et al. 2022

Front. Med.

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ObjectivesPatients with lung cancer pose a high risk of morbidity and mortality after lung resection. Those who receive perioperative cardiopulmonary rehabilitation (PRCR) have better prognosis. Peak oxygen consumption (peak VO2), VO2 at the ventilatory threshold (VO2 at VT), and slope of minute ventilation to carbon dioxide production (VE/VCO2 slope) measured during pre-surgical cardiopulmonary exercise testing (CPET) have prognostic values after lung resection. We aimed to investigate the influence of individualized PRCR on postoperative complications in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer with different pre-surgical risks.MethodsThis was a retrospective study. We recruited 125 patients who underwent VATS for lung cancer between 2017 and 2021. CPET was administered before surgery to evaluate the risk level and PRCR was performed based on the individual risk level defined by peak VO2, VO2 at VT, and VE/VCO2 slope, respectively. The primary outcomes were intensive care unit (ICU) and hospital lengths of stay, endotracheal intubation time (ETT), and chest tube insertion time (CTT). The secondary outcomes were postoperative complications (PPCs), including subcutaneous emphysema, pneumothorax, pleural effusion, atelectasis, infection, and empyema.ResultsThree intergroup comparisons based on the risk level by peak VO2 (3 groups), VO2 at VT (2 groups), and VE/VCO2 slope (3 groups) were done. All of the comparisons showed no significant differences in both the primary and secondary outcomes (p = 0.061–0.910).ConclusionPatients with different risk levels showed comparable prognosis and PPCs after undergoing CPET-guided PRCR. PRCR should be encouraged in patients undergoing VATS for lung cancer.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Chao

Tuan²,

Tang³

et al. 2022

Front. Med.

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“…In particular, guidelines provide standards for measuring oxygen consumption (VO 2 ), such as maximal oxygen consumption (VO 2max ) [9] and peak VO 2 [8,10]. However, owing to the high cost of equipment such as gas analyzers and the need for trained technicians to collect and interpret data, the use of VO 2 assessments for risk prediction in clinical practice is limited [11]. To overcome these limitations in utilizing the CPET in clinical settings, two organizations, the American College of Sports Medicine (ACSM) and the Fitness Registry and Importance of Exercise National Database (FRIEND), have developed equations that estimate VO 2max using information about patients and their exercise tests [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Development of Machine Learning Model for VO2max Estimation Using a Patch-Type Single-Lead ECG Monitoring Device in Lung Resection Candidates

Lee,

Yu,

Choi

et al. 2023

Healthcare

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A cardiopulmonary exercise test (CPET) is essential for lung resection. However, performing a CPET can be challenging. This study aimed to develop a machine learning model to estimate maximal oxygen consumption (VO2max) using data collected through a patch-type single-lead electrocardiogram (ECG) monitoring device in candidates for lung resection. This prospective, single-center study included 42 patients who underwent a CPET at a tertiary teaching hospital from October 2021 to July 2022. During the CPET, a single-lead ECG monitoring device was applied to all patients, and the results obtained from the machine-learning algorithm using the information extracted from the ECG patch were compared with the CPET results. According to the Bland–Altman plot of measured and estimated VO2max, the VO2max values obtained from the machine learning model and the FRIEND equation showed lower differences from the reference value (bias: −0.33 mL·kg−1·min−1, bias: 0.30 mL·kg−1·min−1, respectively). In subgroup analysis, the developed model demonstrated greater consistency when applied to different maximal stage levels and sexes. In conclusion, our model provides a closer estimation of VO2max values measured using a CPET than existing equations. This model may be a promising tool for estimating VO2max and assessing cardiopulmonary reserve in lung resection candidates when a CPET is not feasible.

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“…Вместе с тем функциональное состояние пациента рассматривается в качестве одного из основных предикторов исхода операции [1][2][3][4][5]. Лишь в единичных работах оценивалась прогностическая значимость отдельных параметров электрокардиографии, эхокардиографии (ЭхоКГ), суточного мониторирования электрокардиограммы (ЭКГ), нагрузочных электрокардиографических тестов, эргоспирометрии (ЭСМ), причем в основном -при операциях на крупных сосудах, у пациентов с заведомо высоким риском развития осложнений атеросклероза [4][5][6][7]. Исследований, посвященных прогнозированию кардиальных осложнений при других внесердечных вмешательствах, в том числе при абдоминальных операциях, мало.…”

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Functional Diagnostic Methods in Cardiac Prognosis in Major Abdominal Surgery in Patients with Heart Disease or Over 65 Years Old

et al. 2019

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Purpose of the study. Evaluation of the value of the results of the use of cardiac functional examination methods for the stratification of the risk of developing cardiovascular complications in planned abdominal surgical interventions in patients over 65 years of age or with cardiac pathology.Materials and methods. The study included 179 patients over 65 years of age or with a history of heart disease who underwent elective abdominal surgery. The median age was 70 years. During the operation and for 30 days after it, cardiac complications were recorded: severe (myocardial infarction, stroke, death from cardiovascular disease), others (strokes of exertional angina, ischemic dynamics of the ST segment on the electrocardiogram – ECG – rest, paroxysmal fibrillation / flutter atrial). All patients underwent basic examination – examination, anamnesis, ECG, blood test, assessment of respiratory function, ECG monitoring. Additionally, echocardiography (EchoCG) and ergospirometry (ESM) were performed.Results. In 30 (16.8 %) patients, various MTRs were detected: 6 (3.4 %) of fatal myocardial infarctions, 2 (1.1 %) of fatal strokes; 3 (1.7 %) cases of sudden cardiac death, angina attacks were recorded in 4 (2.2 %) patients, 7 (3.9 %) had ischemic ECG dynamics, 11 (6.1 %) had fibrillation episodes or atrial flutter. Chronic obstructive pulmonary disease, intervention on the colon, blood hemoglobin level <100 g / l, serum creatinine >103 μmol / l, presence of any pathological changes in the resting ECG were associated with the development of SSO; according to EchoCG – VTI (linear velocity integral) in the outflow tract of the left ventricle (LV) <21.5 cm, volume of the left atrium> 57 ml, global LV myocardial deformity is less than 18 %, increase in heart rate (HR) at the 1st minute load test> 27 %, peak oxygen consumption at ESM <15.8 ml / kg / min. The optimal plan for preoperative examination in men is to perform a basic model, and for women it is advisable to combine a basic examination with an ESM or an assessment of the degree of myocardial deformity using the speckle-tracking method for EchoCG.Conclusion. The risk of perioperative MTS during planned abdominal operations in patients older than 65 years or with a history of heart disease is relatively high – 16.8 %. When assessing the risk associated with the operation, it is advisable to additionally conduct echocardiography with VTI assessment in the LV outflow tract and myocardial deformity indicators, as well as ESM with the determination of HR increase in the 1st minute of the test and peak oxygen consumption.

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Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection

Cited by 10 publications

References 0 publications

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Development of Machine Learning Model for VO2max Estimation Using a Patch-Type Single-Lead ECG Monitoring Device in Lung Resection Candidates

Functional Diagnostic Methods in Cardiac Prognosis in Major Abdominal Surgery in Patients with Heart Disease or Over 65 Years Old

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