Critical Care Research Area, NIHR Respiratory BRU, University of Southampton and University Hospital Southampton, Southampton, UK.
Br J Anaesth. 2014 Jan;112(1):57-65. doi: 10.1093/bja/aet370. Epub 2013 Nov 4.
Cardiopulmonary exercise testing by cycle ergometry (CPET(leg)) is an established assessment tool of perioperative physical fitness. CPET utilizing arm ergometry (CPET(arm)) is an attractive alternative in patients with lower limb dysfunction. We aimed to determine whether oxygen uptake obtained by CPET(leg) could be predicted by using CPET(arm) alone and whether CPET(arm) could be used in perioperative risk stratification.
Subjects underwent CPET(arm) and CPET(leg). To evaluate the ability of VO₂ obtained from CPET(arm) to predict VO₂ from CPET(leg), we calculated prediction intervals (PIs) at lactate threshold θ(L) and peak exercise in both groups. Receiver operating characteristic (ROC) curves were used to risk stratify patients into high and low categories based on published criteria.
We recruited 20 vascular surgery patients (17 males and three females) and 20 healthy volunteers (10 males and 10 females). In both groups, PIs for at and peak were wider than clinically acceptable (patient group - VO₂ at θ(L) CPET(arm) ranged from 55% to 108% of CPET(leg) and from 54% to 105% at peak; healthy volunteers - 37-77% and 41-79%, respectively). The area under the ROC for CPET(arm) VO₂ in patients was 0.84 [95% confidence interval (CI): 0.66, 1.0] at θ(L), and 0.76 (95% CI: 0.54, 0.99) at peak.
Although a relationship exists between VO₂ values for CPET(arm) and CPET(leg), this is insufficient for accurate prediction using CPET(arm) alone. This however does not necessarily preclude the use of CPET(arm) in perioperative risk stratification.
通过功率自行车进行心肺运动测试（CPET（leg））是评估围手术期体能的既定工具。在下肢功能障碍的患者中，使用手臂测功仪进行 CPET（CPET（arm））是一种有吸引力的替代方法。我们旨在确定是否可以仅使用 CPET（arm）来预测 CPET（leg）获得的摄氧量，以及 CPET（arm）是否可用于围手术期风险分层。
受试者接受 CPET（arm）和 CPET（leg）。为了评估 CPET（arm）中获得的 VO₂ 预测 CPET（leg）中 VO₂ 的能力，我们计算了两组中乳酸阈θ（L）和峰值运动时的预测区间（PI）。根据已发表的标准，使用接收者操作特征（ROC）曲线将患者分为高风险和低风险类别。
我们招募了 20 名血管外科患者（17 名男性和 3 名女性）和 20 名健康志愿者（10 名男性和 10 名女性）。在两组中，PI 都大于临床可接受范围（患者组：CPET（leg）θ（L）的 CPET（arm）VO₂ 范围为 55%至 108%，峰值时为 54%至 105%；健康志愿者：分别为 37%-77%和 41%-79%）。患者 CPET（arm）VO₂ 的 ROC 曲线下面积在θ（L）时为 0.84 [95%置信区间（CI）：0.66，1.0]，在峰值时为 0.76（95% CI：0.54，0.99）。
尽管 CPET（arm）和 CPET（leg）的 VO₂ 值之间存在关系，但仅凭 CPET（arm）无法进行准确预测。但是，这并不一定排除 CPET（arm）在围手术期风险分层中的应用。
