Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients

Abstract Cardiopulmonary exercise testing (CPET) guidelines recommend analysis of the oxygen (O2) pulse for a late exercise plateau in evaluation for obstructive coronary artery disease (OCAD). However, whether this O2 pulse trajectory is within the range of normal has been debated, and the diagnost...

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Autores principales:	Bradley J. Petek, Timothy W. Churchill, J. Sawalla Guseh, Garrett Loomer, Sarah K. Gustus, Gregory D. Lewis, Rory B. Weiner, Aaron L. Baggish, Meagan M. Wasfy
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	cardiopulmonary exercise testing coronary artery disease exercise testing O2 pulse oxygen pulse Physiology QP1-981
Acceso en línea:	https://doaj.org/article/afbd8caabc854d90abd22a93b770c9bd
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spelling	oai:doaj.org-article:afbd8caabc854d90abd22a93b770c9bd2021-11-15T09:54:40ZUtility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients2051-817X10.14814/phy2.15105https://doaj.org/article/afbd8caabc854d90abd22a93b770c9bd2021-11-01T00:00:00Zhttps://doi.org/10.14814/phy2.15105https://doaj.org/toc/2051-817XAbstract Cardiopulmonary exercise testing (CPET) guidelines recommend analysis of the oxygen (O2) pulse for a late exercise plateau in evaluation for obstructive coronary artery disease (OCAD). However, whether this O2 pulse trajectory is within the range of normal has been debated, and the diagnostic performance of the O2 pulse for OCAD in physically fit individuals, in whom V˙O2 may be more likely to plateau, has not been evaluated. Using prospectively collected data from a sports cardiology program, patients were identified who were free of other cardiac disease and underwent clinically‐indicated CPET within 90 days of invasive or computed tomography coronary angiography. The diagnostic performance of quantitative O2 pulse metrics (late exercise slope, proportional change in slope during late exercise) and qualitative assessment for O2 pulse plateau to predict OCAD was assessed. Among 104 patients (age:56 ± 12 years, 30% female, peak V˙O2 119 ± 34% predicted), the diagnostic performance for OCAD (n = 24,23%) was poor for both quantitative and qualitative metrics reflecting an O2 pulse plateau (late exercise slope: AUC = 0.55, sensitivity = 68%, specificity = 41%; proportional change in slope: AUC = 0.55, sensitivity = 91%, specificity = 18%; visual plateau/decline: AUC = 0.51, sensitivity = 33%, specificity = 67%). When O2 pulse parameters were added to the electrocardiogram, the change in AUC was minimal (−0.01 to +0.02, p ≥ 0.05). Those patients without OCAD with a plateau or decline in O2 pulse were fitter than those with linear augmentation (peak V˙O2 133 ± 31% vs. 114 ± 36% predicted, p < 0.05) and had a longer exercise ramp time (9.5 ± 3.2 vs. 8.0 ± 2.5 min, p < 0.05). Overall, a plateau in O2 pulse was not a useful predictor of OCAD in a physically fit population, indicating that the O2 pulse should be integrated with other CPET parameters and may reflect a physiologic limitation of stroke volume and/or O2 extraction during intense exercise.Bradley J. PetekTimothy W. ChurchillJ. Sawalla GusehGarrett LoomerSarah K. GustusGregory D. LewisRory B. WeinerAaron L. BaggishMeagan M. WasfyWileyarticlecardiopulmonary exercise testingcoronary artery diseaseexercise testingO2 pulseoxygen pulsePhysiologyQP1-981ENPhysiological Reports, Vol 9, Iss 21, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cardiopulmonary exercise testing coronary artery disease exercise testing O2 pulse oxygen pulse Physiology QP1-981
spellingShingle	cardiopulmonary exercise testing coronary artery disease exercise testing O2 pulse oxygen pulse Physiology QP1-981 Bradley J. Petek Timothy W. Churchill J. Sawalla Guseh Garrett Loomer Sarah K. Gustus Gregory D. Lewis Rory B. Weiner Aaron L. Baggish Meagan M. Wasfy Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
description	Abstract Cardiopulmonary exercise testing (CPET) guidelines recommend analysis of the oxygen (O2) pulse for a late exercise plateau in evaluation for obstructive coronary artery disease (OCAD). However, whether this O2 pulse trajectory is within the range of normal has been debated, and the diagnostic performance of the O2 pulse for OCAD in physically fit individuals, in whom V˙O2 may be more likely to plateau, has not been evaluated. Using prospectively collected data from a sports cardiology program, patients were identified who were free of other cardiac disease and underwent clinically‐indicated CPET within 90 days of invasive or computed tomography coronary angiography. The diagnostic performance of quantitative O2 pulse metrics (late exercise slope, proportional change in slope during late exercise) and qualitative assessment for O2 pulse plateau to predict OCAD was assessed. Among 104 patients (age:56 ± 12 years, 30% female, peak V˙O2 119 ± 34% predicted), the diagnostic performance for OCAD (n = 24,23%) was poor for both quantitative and qualitative metrics reflecting an O2 pulse plateau (late exercise slope: AUC = 0.55, sensitivity = 68%, specificity = 41%; proportional change in slope: AUC = 0.55, sensitivity = 91%, specificity = 18%; visual plateau/decline: AUC = 0.51, sensitivity = 33%, specificity = 67%). When O2 pulse parameters were added to the electrocardiogram, the change in AUC was minimal (−0.01 to +0.02, p ≥ 0.05). Those patients without OCAD with a plateau or decline in O2 pulse were fitter than those with linear augmentation (peak V˙O2 133 ± 31% vs. 114 ± 36% predicted, p < 0.05) and had a longer exercise ramp time (9.5 ± 3.2 vs. 8.0 ± 2.5 min, p < 0.05). Overall, a plateau in O2 pulse was not a useful predictor of OCAD in a physically fit population, indicating that the O2 pulse should be integrated with other CPET parameters and may reflect a physiologic limitation of stroke volume and/or O2 extraction during intense exercise.
format	article
author	Bradley J. Petek Timothy W. Churchill J. Sawalla Guseh Garrett Loomer Sarah K. Gustus Gregory D. Lewis Rory B. Weiner Aaron L. Baggish Meagan M. Wasfy
author_facet	Bradley J. Petek Timothy W. Churchill J. Sawalla Guseh Garrett Loomer Sarah K. Gustus Gregory D. Lewis Rory B. Weiner Aaron L. Baggish Meagan M. Wasfy
author_sort	Bradley J. Petek
title	Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
title_short	Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
title_full	Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
title_fullStr	Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
title_full_unstemmed	Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
title_sort	utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/afbd8caabc854d90abd22a93b770c9bd
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Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients

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