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Clinical Investigations: PULMONARY VASCULAR DISEASE |

Reproducibility of Cardiopulmonary Exercise Measurements in Patients With Pulmonary Arterial Hypertension*

James E. Hansen, MD; Xing-Guo Sun, MD; Yuji Yasunobu, MD, PhD; Robert P. Garafano, PhD; Gregory Gates, EdM; Robyn J. Barst, MD; Karlman Wasserman, PhD, MD
Author and Funding Information

*From the Department of Medicine (Drs. Hansen, Sun, Yasunobu, and Wasserman), Research and Education Institute, Harbor-UCLA Medical Center, Torrance, CA; and Department of Pediatrics (Drs. Garafano, Gates, and Barst), Columbia Presbyterian Medical Center, New York, NY.

Correspondence to: James E. Hansen, MD, Box 405, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509; e-mail: jhansen@rei.edu



Chest. 2004;126(3):816-824. doi:10.1378/chest.126.3.816
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Background and objectives: 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.

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

Interventions and measurements: 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 O2 uptake (V̇o2), peak heart rate, peak O2 pulse, anaerobic threshold (AT), and end-tidal Po2, end-tidal Pco2, and the ventilatory equivalent for CO2 at the AT (V̇e/V̇co2@AT).

Results: There were no fatalities or complications occurring among the 242 tests performed on 42 patients. The mean peak V̇o2 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 V̇o2, peak heart rate, peak O2 pulse, end-tidal values at the AT, and V̇e/V̇co2@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.

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