Liverpool Vascular and Endovascular Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
Physiol Rep. 2021 Apr;9(7):e14815. doi: 10.14814/phy2.14815.
Cardiopulmonary exercise testing (CPET) is often used to assess pre-operative fitness in elderly patients, in whom peripheral arterial disease (PAD) is highly prevalent, but may affect the results of CPET by early lactate release due to muscle ischemia. This study investigated the effect revascularization of PAD on oxygen delivery (VO ) during CPET.
We conducted a prospective cohort study of 30 patients, who underwent CPET before and after treatment of ilio-femoral PAD. The primary outcome measure was difference in VO at the lactate threshold (LT) before and after revascularization. Secondary outcome measures were the relationship between change in VO at LT and peak exercise and change in ankle-brachial index (ABI) differential.
The study was approved by the North West-Lancaster Research and Ethics committee (reference 15/NW/0801) and registered in clinicaltrial.gov (reference NCT02657278). As specified in the study protocol, 30 patients were recruited but only 20 (15 men), with a mean age of 62 years, completed pre- and post-treatment CPETs. Twelve patients demonstrated an improvement in VO at LT after revascularization, but the difference did not achieve statistical significance (mean difference (95% CI) = 1.43 (-0.21 to 3.08) ml/kg/min; (p = 0.085). There was, however, a significant improvement in VO , VE/CO , workload and Borg breathlessness and leg fatigue score at peak exercise after revascularization. There was no significant correlation between change in VO at LT (r = -0.11, p = 0.65) or change in VO at peak and ABI differential (r = -0.14, p = 0.55).
Revascularization of PAD led to significant improvement in multiple peak/maximal exercise parameters within a few weeks and without exercise training. We were unable to demonstrate a statistically significant improvement in VO at LT albeit in a majority of subjects this exceeded what we pre-defined as clinically significant.
心肺运动测试（CPET）常用于评估老年患者的术前体能，而外周动脉疾病（PAD）在老年患者中非常普遍，但由于肌肉缺血，早期乳酸释放可能会影响 CPET 的结果。本研究旨在探讨 PAD 血运重建对 CPET 时氧输送（VO ）的影响。
我们对 30 例接受髂股 PAD 治疗前后行 CPET 的患者进行了前瞻性队列研究。主要观察指标为血运重建前后乳酸阈（LT）时 VO 的差异。次要观察指标为 LT 时 VO 变化与峰值运动和踝肱指数（ABI）差异变化的关系。
本研究经西北兰开夏研究和伦理委员会（参考号 15/NW/0801）批准，并在 clinicaltrial.gov 注册（参考号 NCT02657278）。按照研究方案的规定，共招募了 30 例患者，但只有 20 例（15 例男性），平均年龄 62 岁，完成了治疗前后的 CPET。12 例患者在血运重建后 LT 时 VO 改善，但差异无统计学意义（平均差异（95%CI）=1.43（-0.21 至 3.08）ml/kg/min；（p=0.085）。然而，VO 、VE/CO 、工作负荷和 Borg 呼吸困难和腿部疲劳评分在血运重建后峰值运动时均有显著改善。LT 时 VO 变化（r=-0.11，p=0.65）或峰值 VO 与 ABI 差异变化之间无显著相关性（r=-0.14，p=0.55）。
PAD 血运重建在数周内可显著改善多种峰值/最大运动参数，且无需运动训练。尽管大多数患者 LT 时 VO 的改善超过了我们预先定义的临床意义，但我们未能证明其具有统计学意义。
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