Cardiopulmonary exercise test in patients with subacute pulmonary emboli

Yan Topilsky, Courtney L. Hayes, Amber D. Khanna, Thomas G. Allison

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Patients presenting with suspected pulmonary embolism (PE) may present a challenge, particularly if diagnostic testing is not immediately available or clinically not indicated (iodine allergy, pregnancy, renal dysfunction). These patients have abnormal regional gas exchange that can be recognized by a cardiopulmonary exercise test (CPET), which may become helpful in their evaluation. Methods: A retrospective analysis was performed of outpatients evaluated for subacute exertional dyspnea of 2 to 12 weeks duration with a test for PE and CPET. A total of 108 patients met inclusion criteria. Thirty patients (27.8%) had confirmed PE. Results: The patients with PE had increased nadir ventilatory equivalent ratio for carbon dioxide (VE/VCO 2), decreased peak oxygen uptake/predicted, and decreased end exercise saturation (P < .005 for all). All patients but 1 had normal breathing reserve (>15%). A normal nadir VE/VCO 2 excluded PE with 100% sensitivity. By using a "flow chart strategy," the exercise test had 92.8% sensitivity and 92.1% specificity for PE. Eight patients with PE died during follow-up (3.8 ± 4.6 years), 6 of PE-related causes. Peak VO 2/kg was the best predictor of all-cause mortality and nadir VE/VCO 2 for PE-related mortality. There were no serious complications from any of the exercise tests. Conclusion: PE may be excluded by a normal nadir VE/VCO 2 in patients presenting with subacute dyspnea. A combination of decreased peak VO 2/kg, increased nadir VE/VCO 2, normal breathing reserve, and exercise-induced desaturation may be sensitive and specific for PE. CPET may assist in identifying subacute PE in patients with contraindications to use of computed tomography angiography or ventilation perfusion scans.

Original languageEnglish (US)
Pages (from-to)125-136
Number of pages12
JournalHeart and Lung: Journal of Acute and Critical Care
Volume41
Issue number2
DOIs
StatePublished - Mar 2012

Fingerprint

Embolism
Pulmonary Embolism
Exercise Test
Lung
Dyspnea
Breathing Exercises
Mortality
Carbon Dioxide
Iodine
Ventilation
Hypersensitivity
Outpatients
Perfusion
Gases
Exercise
Oxygen
Kidney
Sensitivity and Specificity
Pregnancy

Keywords

  • Exercise test
  • Pulmonary embolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Critical Care and Intensive Care Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Cardiopulmonary exercise test in patients with subacute pulmonary emboli. / Topilsky, Yan; Hayes, Courtney L.; Khanna, Amber D.; Allison, Thomas G.

In: Heart and Lung: Journal of Acute and Critical Care, Vol. 41, No. 2, 03.2012, p. 125-136.

Research output: Contribution to journalArticle

Topilsky, Yan ; Hayes, Courtney L. ; Khanna, Amber D. ; Allison, Thomas G. / Cardiopulmonary exercise test in patients with subacute pulmonary emboli. In: Heart and Lung: Journal of Acute and Critical Care. 2012 ; Vol. 41, No. 2. pp. 125-136.
@article{04947f61177a42978f03ac0261504109,
title = "Cardiopulmonary exercise test in patients with subacute pulmonary emboli",
abstract = "Objective: Patients presenting with suspected pulmonary embolism (PE) may present a challenge, particularly if diagnostic testing is not immediately available or clinically not indicated (iodine allergy, pregnancy, renal dysfunction). These patients have abnormal regional gas exchange that can be recognized by a cardiopulmonary exercise test (CPET), which may become helpful in their evaluation. Methods: A retrospective analysis was performed of outpatients evaluated for subacute exertional dyspnea of 2 to 12 weeks duration with a test for PE and CPET. A total of 108 patients met inclusion criteria. Thirty patients (27.8{\%}) had confirmed PE. Results: The patients with PE had increased nadir ventilatory equivalent ratio for carbon dioxide (VE/VCO 2), decreased peak oxygen uptake/predicted, and decreased end exercise saturation (P < .005 for all). All patients but 1 had normal breathing reserve (>15{\%}). A normal nadir VE/VCO 2 excluded PE with 100{\%} sensitivity. By using a {"}flow chart strategy,{"} the exercise test had 92.8{\%} sensitivity and 92.1{\%} specificity for PE. Eight patients with PE died during follow-up (3.8 ± 4.6 years), 6 of PE-related causes. Peak VO 2/kg was the best predictor of all-cause mortality and nadir VE/VCO 2 for PE-related mortality. There were no serious complications from any of the exercise tests. Conclusion: PE may be excluded by a normal nadir VE/VCO 2 in patients presenting with subacute dyspnea. A combination of decreased peak VO 2/kg, increased nadir VE/VCO 2, normal breathing reserve, and exercise-induced desaturation may be sensitive and specific for PE. CPET may assist in identifying subacute PE in patients with contraindications to use of computed tomography angiography or ventilation perfusion scans.",
keywords = "Exercise test, Pulmonary embolism",
author = "Yan Topilsky and Hayes, {Courtney L.} and Khanna, {Amber D.} and Allison, {Thomas G.}",
year = "2012",
month = "3",
doi = "10.1016/j.hrtlng.2011.06.009",
language = "English (US)",
volume = "41",
pages = "125--136",
journal = "Heart and Lung: Journal of Acute and Critical Care",
issn = "0147-9563",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Cardiopulmonary exercise test in patients with subacute pulmonary emboli

AU - Topilsky, Yan

AU - Hayes, Courtney L.

AU - Khanna, Amber D.

AU - Allison, Thomas G.

PY - 2012/3

Y1 - 2012/3

N2 - Objective: Patients presenting with suspected pulmonary embolism (PE) may present a challenge, particularly if diagnostic testing is not immediately available or clinically not indicated (iodine allergy, pregnancy, renal dysfunction). These patients have abnormal regional gas exchange that can be recognized by a cardiopulmonary exercise test (CPET), which may become helpful in their evaluation. Methods: A retrospective analysis was performed of outpatients evaluated for subacute exertional dyspnea of 2 to 12 weeks duration with a test for PE and CPET. A total of 108 patients met inclusion criteria. Thirty patients (27.8%) had confirmed PE. Results: The patients with PE had increased nadir ventilatory equivalent ratio for carbon dioxide (VE/VCO 2), decreased peak oxygen uptake/predicted, and decreased end exercise saturation (P < .005 for all). All patients but 1 had normal breathing reserve (>15%). A normal nadir VE/VCO 2 excluded PE with 100% sensitivity. By using a "flow chart strategy," the exercise test had 92.8% sensitivity and 92.1% specificity for PE. Eight patients with PE died during follow-up (3.8 ± 4.6 years), 6 of PE-related causes. Peak VO 2/kg was the best predictor of all-cause mortality and nadir VE/VCO 2 for PE-related mortality. There were no serious complications from any of the exercise tests. Conclusion: PE may be excluded by a normal nadir VE/VCO 2 in patients presenting with subacute dyspnea. A combination of decreased peak VO 2/kg, increased nadir VE/VCO 2, normal breathing reserve, and exercise-induced desaturation may be sensitive and specific for PE. CPET may assist in identifying subacute PE in patients with contraindications to use of computed tomography angiography or ventilation perfusion scans.

AB - Objective: Patients presenting with suspected pulmonary embolism (PE) may present a challenge, particularly if diagnostic testing is not immediately available or clinically not indicated (iodine allergy, pregnancy, renal dysfunction). These patients have abnormal regional gas exchange that can be recognized by a cardiopulmonary exercise test (CPET), which may become helpful in their evaluation. Methods: A retrospective analysis was performed of outpatients evaluated for subacute exertional dyspnea of 2 to 12 weeks duration with a test for PE and CPET. A total of 108 patients met inclusion criteria. Thirty patients (27.8%) had confirmed PE. Results: The patients with PE had increased nadir ventilatory equivalent ratio for carbon dioxide (VE/VCO 2), decreased peak oxygen uptake/predicted, and decreased end exercise saturation (P < .005 for all). All patients but 1 had normal breathing reserve (>15%). A normal nadir VE/VCO 2 excluded PE with 100% sensitivity. By using a "flow chart strategy," the exercise test had 92.8% sensitivity and 92.1% specificity for PE. Eight patients with PE died during follow-up (3.8 ± 4.6 years), 6 of PE-related causes. Peak VO 2/kg was the best predictor of all-cause mortality and nadir VE/VCO 2 for PE-related mortality. There were no serious complications from any of the exercise tests. Conclusion: PE may be excluded by a normal nadir VE/VCO 2 in patients presenting with subacute dyspnea. A combination of decreased peak VO 2/kg, increased nadir VE/VCO 2, normal breathing reserve, and exercise-induced desaturation may be sensitive and specific for PE. CPET may assist in identifying subacute PE in patients with contraindications to use of computed tomography angiography or ventilation perfusion scans.

KW - Exercise test

KW - Pulmonary embolism

UR - http://www.scopus.com/inward/record.url?scp=84857360408&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857360408&partnerID=8YFLogxK

U2 - 10.1016/j.hrtlng.2011.06.009

DO - 10.1016/j.hrtlng.2011.06.009

M3 - Article

C2 - 21893343

AN - SCOPUS:84857360408

VL - 41

SP - 125

EP - 136

JO - Heart and Lung: Journal of Acute and Critical Care

JF - Heart and Lung: Journal of Acute and Critical Care

SN - 0147-9563

IS - 2

ER -