Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada; Innovation, Implementation And Clinical Translation in Health, School of Health Sciences, University of South Australia, Adelaide, SA, Australia.
Departments of Medicine and Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada; Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.
Chest. 2020 Dec;158(6):2532-2545. doi: 10.1016/j.chest.2020.06.074. Epub 2020 Jul 14.
Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings.
This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations for predicting peak CPET responses.
Participants were healthy adults who were ≥40 years old from the Canadian Cohort Obstructive Lung Disease who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) with the use of quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters that were measured and predicted in the validation cohort were assessed for equivalence (two one-sided tests of equivalence for paired-samples and level of agreement (Bland-Altman analyses). Two one-sided tests of equivalence for paired samples assessed differences between responses in the derivation cohort using previously recommended reference equations.
Normative reference ranges (5th-95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) who were 64 ± 10 years old. In the validation cohort (n = 84), peak CPET responses that were predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by the previously recommended reference equations by Jones and colleagues and Hansen and colleagues were significantly higher.
This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange, and symptom responses to incremental CPET and presents the most comprehensive reference set to date in Canadian adults who were ≥40 years old to be identified with population-based sampling.
更新心肺运动测试（CPET）的规范参考值对于在临床或研究环境中准确解读 CPET 非常重要。
本研究旨在：（1）通过基于人群抽样的方法，为加拿大成年人建立并验证当代 CPET 峰值反应的参考值；（2）评估之前推荐的预测 CPET 峰值反应的参考方程。
本研究的参与者为加拿大阻塞性肺病队列研究中年龄≥40 岁的健康成年人，他们完成了递增式心肺运动测试。使用分位数回归，根据年龄、性别、身高、体重等易于获得的个体特征，建立预测 CPET 峰值反应的模型。采用第二组健康成年人的便利样本进行外部验证。在验证队列中，测量和预测的 CPET 峰值参数进行等效性评估（配对样本的双侧检验和一致性评估（Bland-Altman 分析）。使用之前推荐的参考方程，在推导队列中使用配对样本的双侧检验评估两组之间的反应差异。
基于 173 名（47%为男性）年龄 64±10 岁的参与者，建立了 28 项 CPET 峰值参数的规范参考范围（第 5 百分位数至第 95 百分位数）和 8 项 CPET 峰值参数的预测模型。在验证队列（n=84）中，新生成模型预测的 CPET 峰值反应与实测值等效。Jones 和 Hansen 等同事之前推荐的参考方程预测的峰值心脏参数明显更高。
本研究提供了基于人群抽样的加拿大≥40 岁成年人递增 CPET 峰值心、肺、运动肺容积、气体交换和症状反应的参考范围和预测模型，这是迄今为止最全面的参考数据集。
