Jaeger Caecilia, Burkard Thilo, Kamber Firmin, Seeberger Esther, Bolliger Daniel, Pfister Otmar, Buse Giovanna Lurati, Mauermann Eckhard
Department of Anesthesiology, University Hospital Basel, Switzerland.
Department of Cardiology, University Hospital Basel, Switzerland.
J Clin Anesth. 2022 Feb;76:110559. doi: 10.1016/j.jclinane.2021.110559. Epub 2021 Oct 20.
Quantifying functional capacity is a core component of preoperative cardiovascular risk assessment. Lower metabolic equivalents (METs) are associated with higher morbidity/mortality in non-surgical and surgical populations. However, actually measuring METs preoperatively is rare. We sought to determine the correlation of self-reported METs using the questionnaire of the MET: REevaluation for Perioperative cArdIac Risk (MET-REPAIR) study and objectively measured METs by gold-standard cardiopulmonary exercise testing (CPET).
Single-center prospective validation study.
University hospital.
We enrolled adult patients aged ≥45 undergoing out-patient cardiac rehabilitation.
Patients completed the MET-REPAIR Questionnaire and the Duke Activity Status Index (DASI), had blood samples drawn, and underwent undergoing routine CPET.
We compared measured METs by CPET to 1) self-reported METs (the MET-REPAIR Questionnaire), 2) the DASI score, 3) stand-alone questions, and 4) N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations.
140 patients were recruited. Measured METs by CPET correlated with 1) self-reported METs by the MET-REPAIR Questionnaire (ρ = 0.489, "fair"), 2) self-reported physical activity by the DASI (ρ = 0.487, "fair"), 3) the self-reported continual stair climbing ability (one of the stand-alone questions; ρ = 0.587, "fair") and 4) NT-proBNP concentrations (ρ = -0.353, "poor"). The area under the receiver operating characteristic curve (AUROC) for the ability to perform more than 4 METs were: highest for flights of stairs (0.841 [95%CI 0.735-0.948], p < 0.05 to rest, optimum: 3 flights), not significantly different between MET-REPAIR Questionnaire and DASI (0.666 [95%CI 0.551-0.781], optimum: 6 METs vs. 0.704 [95%CI 0.578-0.829], optimum: 32.2 points or 6.7 METs, p = 0.405), and not significant for NT-proBNP: (0.623 [95%CI 0.483-0.763]).
The MET-REPAIR Questionnaire correlates with measured METs; all utilized forms of self-reported physical activity overestimate measured METs. NT-proBNP correlates poorly with measured METs.
量化功能能力是术前心血管风险评估的核心组成部分。较低的代谢当量（METs）与非手术和手术人群较高的发病率/死亡率相关。然而，术前实际测量METs的情况很少见。我们试图通过代谢当量：围手术期心脏风险再评估（MET-REPAIR）研究的问卷来确定自我报告的METs与通过金标准心肺运动试验（CPET）客观测量的METs之间的相关性。
单中心前瞻性验证研究。
大学医院。
我们纳入了年龄≥45岁的成年门诊心脏康复患者。
患者完成MET-REPAIR问卷和杜克活动状态指数（DASI），采集血样，并接受常规CPET检查。
我们将CPET测量的METs与以下指标进行比较：1）自我报告的METs（MET-REPAIR问卷），2）DASI评分，3）独立问题，4）N末端脑钠肽前体（NT-proBNP）浓度。
招募了140名患者。CPET测量的METs与以下指标相关：1）MET-REPAIR问卷自我报告的METs（ρ = 0.489，“中等”），2）DASI自我报告的身体活动（ρ = 0.487，“中等”），3）自我报告的连续爬楼梯能力（独立问题之一；ρ = 0.587，“中等”），4）NT-proBNP浓度（ρ = -0.353，“差”）。进行超过4个METs能力的受试者工作特征曲线下面积（AUROC）为：爬楼梯能力最高（0.841 [95%CI 0.735 - 0.948]，与静息状态相比p < 0.05，最佳：3层楼梯），MET-REPAIR问卷和DASI之间无显著差异（0.666 [95%CI 0.551 - 0.781]，最佳：6个METs vs. 0.704 [95%CI 0.578 - 0.829]，最佳：32.2分或6.7个METs，p = 0.405），NT-proBNP无显著差异：（0.623 [95%CI 0.483 - 0.763]）。
MET-REPAIR问卷与测量的METs相关；所有自我报告的身体活动形式均高估了测量的METs。NT-proBNP与测量的METs相关性较差。
