Plantier Laurent, Delclaux Christophe
INSERM UMR 1152, Labex Inflamex, Paris, France.
Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.
Eur Clin Respir J. 2018 Jul 5;5(1):1492842. doi: 10.1080/20018525.2018.1492842. eCollection 2018.
: The characteristics of cardiopulmonary exercise testing (CPET)-derived parameters for the differential diagnosis of exertional dyspnea are not well known. We hypothesized that increased physiological dead space ventilation (VD/Vt) is a marker for mild pulmonary or cardiovascular disease in patients with exertional dyspnea. We used receiver operating characteristic analysis to determine the performance of individual CPET parameters for identifying subjects with either mild pulmonary or cardiovascular disease, among 77 subjects with mild-to-moderate exertional dyspnea (modified Medical Research Council scale 1-2). : In comparison with subjects without disease, subjects with pulmonary disease ( = 31) had higher VE/V'CO slope, higher VD/Vt, and lower ventilatory reserve. Subjects with cardiovascular disease ( = 14) had lower heart rate and cardiovascular double product and higher VD/Vt at peak exercise. At a threshold of 28%, the sensitivity and specificity of VD/Vt at peak exercise for identifying pulmonary or cardiovascular disease were 89% (95% CI: 64-98%) and 72% (95% CI: 46-89%), respectively. : Increased physiological VD/Vt at exercise is a sensitive and specific marker of mild pulmonary or cardiovascular disease in dyspneic subjects.
心肺运动试验（CPET）衍生参数用于鉴别诊断劳力性呼吸困难的特征尚不清楚。我们假设，生理死腔通气增加（VD/Vt）是劳力性呼吸困难患者轻度肺部或心血管疾病的一个标志物。我们采用受试者工作特征分析来确定个体CPET参数在77例轻至中度劳力性呼吸困难患者（改良医学研究委员会量表1 - 2级）中识别轻度肺部或心血管疾病患者的效能。与无疾病的受试者相比，肺部疾病患者（n = 31）的VE/V'CO斜率更高、VD/Vt更高且通气储备更低。心血管疾病患者（n = 14）运动峰值时心率和心血管双乘积更低，VD/Vt更高。运动峰值时VD/Vt鉴别肺部或心血管疾病的阈值为28%时，其敏感性和特异性分别为89%（95%CI：64 - 98%）和72%（95%CI：46 - 89%）。运动时生理性VD/Vt增加是呼吸困难患者轻度肺部或心血管疾病的一个敏感且特异的标志物。
