Reproducibility of cardiopulmonary exercise measurements in patients with pulmonary arterial hypertension.
OBJECTIVE
As part of a recent study, cardiopulmonary exercise tests (CPETs) were used to evaluate and follow up patients with pulmonary arterial hypertension (PAH). These patients were more impaired than those in other published series evaluating CPET reproducibility. We used these patient tests to assess patient performance variability and evaluate reading variability. To achieve this end, six independent evaluators graded key CPET measurements in patients with PAH who underwent duplicate CPETs within 3 days of each other.


METHODS
Over a 15-month period at two tertiary-care teaching hospitals, 42 patients with PAH underwent repeated, paired CPETs using cycle ergometry.


METHODS
Each patient underwent one to six pairs of cycle ergometry tests to maximal tolerance. Each pair of tests was separated by 3 months, with each test in the pair separated by 1 to 3 days. Specific guidelines were given to the independent evaluators for the key measurements assessed from each CPET study: peak O(2) uptake (Vo(2)), peak heart rate, peak O(2) pulse, anaerobic threshold (AT), and end-tidal Po(2), end-tidal Pco(2), and the ventilatory equivalent for CO(2) at the AT (Ve/Vco(2)@AT).


RESULTS
There were no fatalities or complications occurring among the 242 tests performed on 42 patients. The mean peak Vo(2) was 722 mL/min or 41% of predicted; 34 patients were Weber class C or D. Using the specific guidelines to measure the variability of measurements made by the six independent evaluators, the coefficients of variation were < 2.2% for peak Vo(2), peak heart rate, peak O(2) pulse, end-tidal values at the AT, and Ve/Vco(2)@AT, while for the AT, it was 8.5%. There were no significant differences in these measurements between the first and second tests of any pair or between the earlier and later sets of pairs.


CONCLUSIONS
Using specific guidelines, key CPET measurements can be safely, reliably, and reproducibly assessed even in patients with severe exercise intolerance.
Hansen
James E
JE
Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA. jhansen@rei.edu
Sun
Xing-Guo
XG
Yasunobu
Yuji
Y
Garafano
Robert P
RP
Gates
Gregory
G
Barst
Robyn J
RJ
Wasserman
Karlman
K
D000293:Adolescent; D000328:Adult; D015308:Anaerobic Threshold / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010100:Oxygen / Q000097:blood; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D013990:Tidal Volume / Q000502:physiology
D002245:Carbon Dioxide; D010100:Oxygen