Reliability of the Determination of the Ventilatory Threshold in Patients with COPD.
OBJECTIVE
The purpose of this study was to determine the interobserver reliability of the assessment of the ventilatory threshold (VT) using two methods in patients with chronic obstructive pulmonary disease (COPD) and in control subjects.


METHODS
VT was identified from incremental exercise testing graphs of 115 subjects (23 controls and 23 in each COPD Global initiative for chronic Obstructive Lung Disease class) by two human observers and a computer analysis using the V-slope method and the ventilatory equivalent method (VEM). Agreement between observers in identifying oxygen uptake at VT (VO 2VT) and HR at VT (HR VT) across disease severity groups was evaluated using intraclass correlation (for humans) and Passing-Bablok regression analysis (human vs computer).


RESULTS
For human observers, ICC (95% confidence interval) in determining VO 2VT were higher in controls (0.98 (0.97-0.99) both with V-slope and with VEM) than those in COPD patients (0.72 (0.60-0.81) with V-slope and 0.64 (0.50-0.74) with VEM). Passing-Bablok analysis showed that human and computerized determination of VO 2VT was interchangeable in controls but not in patients with COPD. Forced expiratory volume in one second and peak minute ventilation during exercise were the only variables independently associated with greater interobserver differences in VO 2VT. Interobserver differences in HRVT ranged from 2 ± 1 (controls) to 10 ± 3 bpm (GOLD 4).


CONCLUSIONS
In patients with COPD, the reliability of human estimation of VO 2VT is less than that in controls and not interchangeable with a computerized analysis. This should be taken into account when using VT for exercise prescription, as a tool to monitor responses to an intervention, as a surrogate measure of overall aerobic fitness, or as a prognostic marker in patients with COPD.
1Department of Exercise Science, Concordia University, Montreal, CANADA; 2Faculty of Medicine, University of Montreal, Montreal, CANADA; 3Hôpital du Sacré-Cœur, Montreal, CANADA; and 4Research Center, Hôpital du Sacré-Cœur, Montreal, CANADA.
Bruno-Pierre
BP
Dubé
Myriam
M
Mesbahi
François
F
Beaucage
Véronique
V
Pepin
D015308:Anaerobic Threshold / Q000502:physiology*; D003936:Diagnosis, Computer-Assisted; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D015203:Reproducibility of Results; D012984:Software