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A Summed Score From Cardiopulmonary Exercise Test Parameters Predicts 1-Year Mortality in Newly Diagnosed
Yuan-Yang Cheng1, Yu-Chun Lee2, Yu-Wan Liao3
1Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 40705, Taiwan; and Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40200, Taiwan.
Insights
Cardiopulmonary exercise testing (CPET) can predict mortality in interstitial lung disease (ILD) patients. A summed score of CPET variables effectively identifies individuals at high risk of 1-year mortality.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Exercise Physiology
Background:
- Cardiopulmonary exercise testing (CPET) assesses integrated cardiopulmonary and oxidative function.
- The prognostic value of CPET in interstitial lung disease (ILD) requires further clarification.
Purpose of the Study:
- To evaluate the predictive capability of CPET for mortality in patients diagnosed with ILD.
Main Methods:
- Prospective enrollment of 106 newly diagnosed ILD patients undergoing CPET.
- 12-month survival follow-up to identify mortality predictors.
- Receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for significant CPET parameters.
Main Results:
- The 1-year mortality rate was 7.5%.
- Six CPET variables (peak oxygen consumption, oxygen pulse, end-tidal partial pressure of carbon dioxide, heart rate recovery, minute ventilation to carbon dioxide output slope, functional aerobic impairment) significantly predicted mortality.
- A summed score based on these variables showed distinct survival rates: 25% for a score of 6 versus 98% for scores of 0-5 at 1 year.
Conclusions:
- A summed score derived from CPET parameters is a valuable tool for prognostication in ILD patients.
- CPET can effectively screen ILD patients for risk stratification and prognosis assessment.
Background:
Cardiopulmonary exercise testing (CPET) is a unique diagnostic tool that assesses the functional capacity of the heart, lungs, and peripheral oxidative system in an integrated manner. However, the clinical utility of CPET for evaluating interstitial lung disease (ILD) remains uncertain. The objective of this study was to determine the predictive value of CPET for mortality in subjects with ILD.
Methods:
We prospectively enrolled subjects with ILD who underwent CPET at a tertiary medical center in Taiwan and followed up their survival status for 12 months. Mortality prediction was based on comparing CPET parameters between subjects who survived and those who died. We further analyzed CPET parameters that showed significant differences using receiver operating characteristic curves to identify their optimal cutoff values.
Results:
A total of 106 newly diagnosed subjects with ILD underwent CPET, and the 1-y mortality rate was 7.5%. Six CPET variables were found to be significant predictors of mortality: peak oxygen consumption, oxygen pulse, end-tidal partial pressure of carbon dioxide, heart rate recovery 1 min after CPET, minute ventilation to carbon dioxide output slope, and functional aerobic impairment. We calculated a summed score by adding the number of CPET variables that exceeded their cutoff values. Subjects with a summed score of 6 had a 1-y survival rate of only 25%, whereas subjects with scores of 0-5 had a survival rate of 98%.
Conclusions:
In conclusion, the summed score represents a useful tool for screening patients with ILD who can undergo a CPET to determine their prognosis.
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