Adelson School of Medicine, Ariel University, Ariel, Israel; Pulmonary Clinic, Dan-Petah-Tiqwa District, Clalit Health Services - Community Division, Ramat-Gan, Israel.
Department of Surgical Oncology (Surgery C), Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Pulmonology. 2024 Sep-Oct;30(5):452-458. doi: 10.1016/j.pulmoe.2022.12.003. Epub 2023 Jan 28.
Evaluation of unexplained exercise intolerance is best resolved by cardiopulmonary exercise testing (CPET) which enables the determination of the exercise limiting system in most cases. Traditionally, pulmonary function tests (PFTs) at rest are not used for the prediction of a respiratory limitation on CPET.
We sought cut-off values on PFTs that might, a priori, rule-in or rule-out a respiratory limitation in CPET.
Patients who underwent CPET in our institute were divided into two groups according to spirometry: obstructive and non-obstructive. Each group was randomly divided 2:1 into derivation and validation cohorts respectively. We analyzed selected PFTs parameters in the derivation groups in order to establish maximal and minimal cut-off values for which a respiratory limitation could be ruled-in or ruled-out. We then validated these values in the validation cohorts.
Of 593 patients who underwent a CPET, 126 were in the obstructive and 467 in the non-obstructive group. In patients with obstructive lung disease, forced expiratory volume in 1 second (FEV) ≥ 61% predicted could rule out a respiratory limitation, while FEV ≤ 33% predicted was always associated with a respiratory limitation. For patients with non-obstructive spirometry, FEV of ≥ 73% predicted could rule-out a respiratory limitation. Application of this algorithm might have saved up to 47% and 71% of CPETs in our obstructive and non-obstructive groups, respectively.
Presence or absence of a respiratory limitation on CPET can be predicted in some cases based on a PFTs performed at rest.
评估不明原因的运动不耐受最好通过心肺运动测试（CPET）来解决，这可以确定大多数情况下的运动限制系统。传统上，静息时的肺功能测试（PFT）不用于预测 CPET 上的呼吸限制。
我们寻求 PFT 的截止值，这些截止值可以预先确定 CPET 上是否存在呼吸限制。
在我们的研究所进行 CPET 的患者根据肺量计分为两组：阻塞性和非阻塞性。每组随机分为 2:1 的推导和验证队列。我们分析了推导组中选定的 PFT 参数，以确定可以确定或排除呼吸限制的最大和最小截止值。然后在验证队列中验证这些值。
在接受 CPET 的 593 名患者中，126 名患者患有阻塞性肺病，467 名患者患有非阻塞性肺病。在患有阻塞性肺病的患者中，1 秒用力呼气量（FEV）≥61%预测值可以排除呼吸限制，而 FEV≤33%预测值始终与呼吸限制相关。对于非阻塞性肺量计患者，FEV≥73%预测值可以排除呼吸限制。在我们的阻塞性和非阻塞性组中，应用该算法可能分别节省了多达 47%和 71%的 CPET。
在某些情况下，可以根据静息时进行的 PFT 来预测 CPET 上是否存在呼吸限制。
