Xu Fan, Sun Xing-Guo, Liu Fang, Zhai Wen-Xuan, Song Ya, Tai Wen-Qi, Wang Ji-Nan, Zhang Yan-Fang, Zhou Qing-Qing, Shi Chao, Xie Ben, Chen Jia-Hao, Huang Jiang, Zhang Zeng-Fei, Xiang Meng-Jun, Ye Shao-Dong, Li Lin
Department of Functional Testing Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, National Research Center of Clinical Medicine for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Rehabilitation Medicine, The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing, China.
J Thorac Dis. 2025 Jun 30;17(6):3863-3872. doi: 10.21037/jtd-24-525. Epub 2025 Jun 26.
Gas exchange measurements, such as oxygen uptake ( ) and carbon dioxide output ( ), of cardiopulmonary exercise testing (CPET), are the key and gold standard for human cardiopulmonary functional evaluation. However, in terms of quality control, they are unstable and inaccurate. We used a metabolic simulator (MS) to detect measurement errors and enhance quality control.
In the Fuwai CPET laboratory, we performed CPET after systems had: (I) passed all the steps of regular system calibrations for flow and the partial pressure of O and CO; and (II) passed the MS validation of and at low, medium, and high metabolic rates (MRs) daily from 2014 to 2023 for eight different CPET carts/systems. The absolute percentage difference of the 1 validation of both and was calculated as follows: |[(measured - ideal) / ideal] × 100%|. A difference of <10% was set as the 1 validation pass standard to run the laboratory, while a difference of ≥10% was classified as a 1 validation failure. The absolute percentage difference of the 1 validation among the eight carts/systems was compared using the Kruskal-Wallis H test. The rate of the 1 validation failure, the number of validation days, and the median absolute percentage difference of the 1 validation among the different CPET carts/systems were clustered using the hierarchical clustering method.
In total, we completed 1,810 validation days for the eight CPET carts/systems, and found a 10,860 absolute percentage difference of the 1 validation of and . The number of validation days completed by each cart/system and the 1 validation failure rates were as follows: 8 (87.50%), 10 (90.00%), 54 (48.15%), 349 (43.27%), 20 (45.00%), 759 (21.21%), 525 (29.52%), and 85 (22.35%), respectively. The overall absolute percentage difference of the 1 validation of each cart/system was 7.32% (P, P: 3.67%, 13.82%), 9.12% (P, P: 3.33%, 30.4%), 6.82% (P, P: 4.31%, 9.06%), 5.40% (P, P: 2.60%, 8.26%), 4.90% (P, P: 2.21%, 9.68%), 4.32% (P, P: 2.17%, 6.78%), 5.62% (P, P: 2.96%, 8.19%), and 5.35% (P, P: 2.55%, 7.81%), respectively. The Kruskal-Wallis H test results revealed significant differences among the eight carts/systems (H=274.86, P<0.001), and the pairwise comparisons showed that cart/system F had the lowest absolute percentage difference of 4.32% (P, P: 2.17%, 6.78%). The hierarchical cluster classified carts/systems A and B as one cluster, carts/systems C, E, and H as another cluster, and carts/systems D, F, and G as yet another cluster.
Using an MS can decrease measurement errors and variability for CPET. It can also improve the quality control of CPET.
心肺运动试验（CPET）中的气体交换测量，如摄氧量（ ）和二氧化碳排出量（ ），是人体心肺功能评估的关键和金标准。然而，在质量控制方面，它们不稳定且不准确。我们使用代谢模拟器（MS）来检测测量误差并加强质量控制。
在阜外CPET实验室，我们在系统完成以下操作后进行CPET：（I）通过流量以及氧气和二氧化碳分压的常规系统校准的所有步骤；（II）在2014年至2023年期间，每天对八个不同的CPET推车/系统在低、中、高代谢率（MR）下进行 和 的MS验证。 和 的第一次验证的绝对百分比差异计算如下：|[(测量值 - 理想值) / 理想值]×100%|。将差异<10%设定为实验室运行的第一次验证通过标准，而差异≥10%则归类为第一次验证失败。使用Kruskal-Wallis H检验比较八个推车/系统之间第一次验证的绝对百分比差异。使用层次聚类方法对不同CPET推车/系统之间的第一次验证失败率、验证天数以及第一次验证的中位绝对百分比差异进行聚类。
我们总共为八个CPET推车/系统完成了1810天的验证，发现 和 的第一次验证的绝对百分比差异为10860。每个推车/系统完成的验证天数和第一次验证失败率如下：分别为8天（87.50%）、10天（90.00%）、54天（48.15%）、349天（43.27%）、20天（45.00%）、759天（21.21%）、525天（29.52%）和85天（22.35%）。每个推车/系统第一次验证的总体绝对百分比差异分别为7.32%（ ， ：3.67%，13.82%）、9.12%（ ， ：3.33%，30.4%）、6.82%（ ， ：4.31%，9.06%）、5.40%（ ， ：2.60%，8.26%）、4.90%（ ， ：2.21%，9.68%）、4.32%（ ， )：2.17%，6.78%）、5.62%（ ， ：2.96%，8.19%）和5.35%（ ， ：2.55%，7.81%）。Kruskal-Wallis H检验结果显示八个推车/系统之间存在显著差异（H = 274.86，P < 0.001），两两比较表明推车/系统F的绝对百分比差异最低，为4.32%（ ， ：2.17%，6.78%）。层次聚类将推车/系统A和B归为一个聚类，推车/系统C、E和H归为另一个聚类，推车/系统D、F和G归为另一个聚类。
使用MS可以减少CPET的测量误差和变异性。它还可以改善CPET的质量控制。
