Carr Zyad James, Agarkov Daniel, Li Judy, Charchaflieh Jean, Brenes-Bastos Andres, Freund Jonah, Zafar Jill, Schonberger Robert B, Heerdt Paul
Department of Anesthesiology, Yale University, New Haven, CT, United States.
School of Medicine, Yale University, New Haven, CT, United States.
JMIR Perioper Med. 2025 Feb 17;8:e65805. doi: 10.2196/65805.
Precise functional capacity assessment is a critical component for preoperative risk stratification. Brief submaximal cardiopulmonary exercise testing (smCPET) has shown diagnostic utility in various cardiopulmonary conditions.
This study aims to determine if smCPET could be implemented in a high-volume presurgical evaluation clinic and, when compared to structured functional capacity surveys, if smCPET could better discriminate low functional capacity (≤4.6 metabolic equivalents [METs]).
After institutional approval, 43 participants presenting for noncardiac surgery who met the following inclusion criteria were enrolled: aged 60 years and older, a Revised Cardiac Risk Index of ≤2, and self-reported METs of ≥4.6 (self-endorsed ability to climb 2 flights of stairs). Subjective METs assessments, Duke Activity Status Index (DASI) surveys, and a 6-minute smCPET trial were conducted. The primary end points were (1) operational efficiency, based on the time of the experimental session being ≤20 minutes; (2) modified Borg survey of perceived exertion, with a score of ≤7 indicating no more than moderate exertion; (3) high participant satisfaction with smCPET task execution, represented as a score of ≥8 (out of 10); and (4) high participant satisfaction with smCPET scheduling, represented as a score of ≥8 (out of 10). Student's t test was used to determine the significance of the secondary end points. Correlation between comparable structured surveys and smCPET measurements was assessed using the Pearson correlation coefficient. A Bland-Altman analysis was used to assess agreement between the methods.
The mean session time was 16.9 (SD 6.8) minutes. The mean posttest modified Borg survey score was 5.35 (SD 1.8). The median patient satisfaction (on a scale of 1=worst to 10=best) was 10 (IQR 10-10) for scheduling and 10 (IQR 9-10) for task execution. Subjective METs were higher when compared to smCPET equivalents (extrapolated peak METs; mean 7.6, SD 2.0 vs mean 6.7, SD 1.8; t=2.1; P<.001). DASI-estimated peak METs were higher when compared to smCPET peak METs (mean 8.8, SD 1.2 vs mean 6.7, SD 1.8; t=7.2; P<.001). DASI-estimated peak oxygen uptake was higher than smCPET peak oxygen uptake (mean 30.9, SD 4.3 mL kg min vs mean 23.6, SD 6.5 mL kg min; t=7.2; P<.001).
Implementation of smCPET in a presurgical evaluation clinic is both patient centered and clinically feasible. Brief smCPET measures, supportive of published reports regarding low sensitivity of provider-driven or structured survey measures for low functional capacity, were lower than those from structured surveys. Future studies will analyze the prediction of perioperative complications and cost-effectiveness.
ClinicalTrials.gov NCT05743673; https://clinicaltrials.gov/study/NCT05743673.
精确的功能能力评估是术前风险分层的关键组成部分。简短次极量心肺运动试验（smCPET）已在各种心肺疾病中显示出诊断效用。
本研究旨在确定smCPET是否可在高流量的术前评估诊所实施，以及与结构化功能能力调查相比，smCPET是否能更好地鉴别低功能能力（≤4.6代谢当量[METs]）。
经机构批准后，纳入43名因非心脏手术前来就诊且符合以下纳入标准的参与者：年龄60岁及以上、修订心脏风险指数≤2、自我报告的METs≥4.6（自我认可能够爬两层楼梯）。进行了主观METs评估、杜克活动状态指数（DASI）调查以及6分钟的smCPET试验。主要终点为：（1）操作效率，基于实验时间≤20分钟；（2）改良的Borg自觉用力程度调查，得分≤7表明用力程度不超过中度；（3）参与者对smCPET任务执行的高度满意度，以≥8分（满分10分）表示；（4）参与者对smCPET安排的高度满意度，以≥8分（满分10分）表示。采用学生t检验确定次要终点的显著性。使用Pearson相关系数评估可比结构化调查与smCPET测量之间的相关性。采用Bland - Altman分析评估两种方法之间的一致性。
平均试验时间为16.9（标准差6.8）分钟。测试后改良Borg调查的平均得分为5.35（标准差1.8）。患者对安排的满意度中位数（范围为1 =最差至10 =最好）为10（四分位间距10 - 10），对任务执行的满意度中位数为10（四分位间距9 - 10）。与smCPET等效值（推算的峰值METs）相比，主观METs更高（平均7.6，标准差2.0 vs平均6.7，标准差1.8；t = 2.1；P <.001）。与smCPET峰值METs相比，DASI估计的峰值METs更高（平均8.8，标准差1.2 vs平均6.7，标准差1.8；t = 7.2；P <.001）。DASI估计的峰值摄氧量高于smCPET峰值摄氧量（平均30.9，标准差4.3 mL·kg⁻¹·min vs平均23.6，标准差6.5 mL·kg⁻¹·min；t = 7.2；P <.001）。
在术前评估诊所实施smCPET以患者为中心且在临床上可行。简短的smCPET测量结果低于结构化调查结果，这支持了已发表的关于医生主导或结构化调查测量对低功能能力敏感性较低的报告。未来的研究将分析围手术期并发症的预测及成本效益。
ClinicalTrials.gov NCT05743673；https://clinicaltrials.gov/study/NCT05743673
