IngentaConnect Cardiopulmonary Exercise Test Interpretation Using Age-Matched Co...

Authors: Sill, Joshua M.¹; Morris, Michael J.¹; Johnson, James E.²; Allan, Patrick F.³; Grbach, Vincent X.⁴

Source: Military Medicine, Volume 174, Number 11, November 2009 , pp. 1177-1182(6)

Publisher: AMSUS - Association of Military Surgeons of the U.S.

Abstract:

ABSTRACT

Background: Cardiopulmonary exercise testing (CPET) is one method to diagnose unexplained dyspnea in young adults, yet few normal reference values exist in this population. This study evaluated interpretation of maximal CPET in a young adult cohort with known pulmonary disorders using published reference values compared to age-matched normal controls. Methods: A control population of 69 healthy military volunteers with normal chest radiographs, pulmonary function testing, and bronchoprovocation testing were compared to 105 patients with exertional dyspnea. Both groups underwent a standardized evaluation including CPET on a graded exercise treadmill to maximal exercise with expired gas analysis. Results: Measurements from CPET in the dyspnea group were interpreted using published reference values compared to control population results (mean ± 1.65 × SD). Statistical comparison of predicted normals (reference vs. control) of maximal oxygen consumption (>83% vs. 82%), ventilatory anaerobic threshold (>40% vs. 53%), respiratory rate (<60 vs. 56 breaths/min), tidal volume to inspiratory capacity (<80% vs. 111%), ventilatory equivalent for carbon dioxide production (<40 vs. 38), and maximal voluntary ventilation minus minute ventilation (>11 vs. −1 L/min) was performed. The overall specificity for tidal volume to inspiratory capacity improved using age-matched controls but sensitivity was decreased. Other parameters were not significantly different. Conclusions: The use of age-matched controls for CPET results in an increase in specificity and decrease in sensitivity for respiratory limitations to exercise, when compared to reference values. The study findings suggest that CPET may be insensitive in detecting mild disease in young healthy adults.

Document Type: Research article

Affiliations: 1: Pulmonary Disease/Critical Care Medicine Service, Department of Medicine, Brooke Army Medical Center, 3851 Roger Brooke Road, Fort Sam Houston, TX 78234-6200. 2: Pulmonary and Critical Care Medicine, University of Alabama Birmingham, 2000 6th Avenue S., Birmingham, AL 35233. 3: Pulmonary Disease/Critical Care Service, Landstuhl Regional Medical Center, Germany, CMR 402, APO: AE 09180-0402. 4: Pulmonary Disease/Critical Care Service, Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.

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Cardiopulmonary Exercise Test Interpretation Using Age-Matched Controls to Evaluate Exertional Dyspnea