Cardiopulmonary Exercise Testing for Risk Prediction in Major Abdominal Surgery

Levett, Denny; Grocott, Michael P.W.

doi:10.1016/j.anclin.2014.11.001

Cited by 53 publications

(47 citation statements)

References 101 publications

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“…Preoperative functional capacity has been reported to be an important predictor of postoperative outcome [18,19]. Functional capacity reflects underlying physiological reserve, indicating the ability to endure the physiological stress of major surgery and the harmful effects of prolonged postsurgical bed rest and poor perioperative nutritional intake.…”

Section: The Impact Of Surgery On the Elderlymentioning

confidence: 99%

The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program

2017

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Section: The Impact Of Surgery On the Elderlymentioning

confidence: 99%

The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program

2017

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“…2,3 The European Society of Intensive Care Medicine and the European Society of Anaesthesiology reported 4% mortality and 16-18% morbidity rates in patients admitted to noncardiac surgery, suggesting the importance of implementing measures to improve surgical outcomes. 4,5 As life expectancy increases, a growing proportion of patients are likely to be high-risk elderly patients with multiple comorbidities who present risk stratification challenges to both anesthesiologists and surgeons. 5 The ventilatory threshold (VT)-derived from a cardiopulmonary exercise test (CPET)-has been widely used in assessing both athletes and patients with cardio pulmonary disease, and it has recently been shown to be a good prognostic marker in the context of surgical outcomes.…”

Section: Résumémentioning

confidence: 99%

“…4,5 As life expectancy increases, a growing proportion of patients are likely to be high-risk elderly patients with multiple comorbidities who present risk stratification challenges to both anesthesiologists and surgeons. 5 The ventilatory threshold (VT)-derived from a cardiopulmonary exercise test (CPET)-has been widely used in assessing both athletes and patients with cardio pulmonary disease, and it has recently been shown to be a good prognostic marker in the context of surgical outcomes. 5,6,[8][9][10][11][12] Ventilatory threshold values were associated with morbidity, mortality, surgery complications, and length of hospital stay.…”

Section: Résumémentioning

confidence: 99%

“…5 The ventilatory threshold (VT)-derived from a cardiopulmonary exercise test (CPET)-has been widely used in assessing both athletes and patients with cardio pulmonary disease, and it has recently been shown to be a good prognostic marker in the context of surgical outcomes. 5,6,[8][9][10][11][12] Ventilatory threshold values were associated with morbidity, mortality, surgery complications, and length of hospital stay. 5,[12][13][14][15][16][17] The VT is defined as an exercise intensity beyond which the increase in ventilation becomes disproportionate to the increase in power output or oxygen uptake during progressive exercise.…”

Section: Résumémentioning

confidence: 99%

“…5,6,[8][9][10][11][12] Ventilatory threshold values were associated with morbidity, mortality, surgery complications, and length of hospital stay. 5,[12][13][14][15][16][17] The VT is defined as an exercise intensity beyond which the increase in ventilation becomes disproportionate to the increase in power output or oxygen uptake during progressive exercise. 11,18 This measure provides important information regarding the major physiological systems involved in aerobic exercise and constitutes a determinant of an individual's functional capabilities and cardiorespiratory performance.…”

Section: Résumémentioning

confidence: 99%

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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

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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.

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The double anaerobic threshold in heart failure: MECKI score database overview

et al. 2022

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Aims In heart failure (HF), anaerobic threshold (AT) may be indeterminable but its value held a relevant prognostic role. AT is evaluated joining three methods: V‐slope, ventilatory equivalent, and end‐tidal methods. The possible non‐concordance between the V‐slope (met AT) and the other two methods (vent AT) has been highlighted in healthy individuals and named double threshold (DT). Methods and results We reanalysed 1075 cardiopulmonary exercise tests of HF patients recruited in the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score database. We identified DT in 43% of cases. Met AT precedes vent AT being met–ventΔVO2 221 (interquartile range: 129–319) mL/min. Peak VO2, 1307 ± 485 vs. 1343 ± 446 mL/min (63 ± 17 vs. 63 ± 17 percentage of predicted), was similar between DT+ and DT− patients. Differently, DT+ showed a lower ventilatory vs. carbon dioxide production (VE/VCO2) slope (29.6 ± 6.1 vs. 31.0 ± 6.3), a lower peak exercise end‐tidal oxygen tension (PetO2) 115.3 (111.5–118.9) vs. 116.4 (112.4–120.2) mmHg, and a higher carbon dioxide tension (PetCO2) 34.2 (30.9–37.1) vs. 32.4 (28.7–35.5) mmHg. Vent AT showed a significant higher VO2, 957 ± 318 vs. 719 ± 252 mL/min, VCO2, 939 ± 319 vs. 627 ± 226 mL/min, ventilation, 31.0 ± 8.3 vs. 22.5 ± 6.3 L/min, respiratory exchange ratio, 0.98 ± 0.08 vs. 0.87 ± 0.07, PetO2, 108 (104–112) vs. 105 (101–109) mmHg, PetCO2, 37 (34–40) vs. 36 (33–39) mmHg, and VE/VO2 ratio, 33.5 ± 6.7 vs. 32.6 ± 6.9, but lower VE/VCO2 ratio, 33 (30–37) vs. 36 (32–41), compared with met AT. At 2 year survival by Kaplan–Meier analysis, even adjusted for confounders, DT resulted not associated with survival. Conclusions Double threshold is frequently observed in HF patients. DT+ is associated to a decreased ventilatory response during exercise.

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Cardiopulmonary Exercise Testing for Risk Prediction in Major Abdominal Surgery

Cited by 53 publications

References 101 publications

The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program

The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program

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

The double anaerobic threshold in heart failure: MECKI score database overview

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