Abstract
Introduction: The peak oxygen uptake (VO2) obtained in CPET is a good predictor of postoperative morbimortality in LCS. However some preoperative risk assessment algorithms include “low-technology exercise tests” as the ISWT.
We compared the algorithms proposed in the guidelines ACCP 2013* which includes ISWT performance and those of the ERS/ESTS 2009**.
Methods: Patients who were candidates for pulmonary resection from September 2017 to November 2018 were included. Spirometry, lung volumes, DLCO and arterial blood gase were performed. Patients with FEV1% or DLCO <80% of the reference value, underwent CPET and IWST.
Preoperative risk was calculated according to both guidelines and the concordance between them was analyzed.
Results: 41 patients were included (28 men); mean age 65, mean FEV1 62% and DLCO 54%. The mean peak VO2 was 17.1 +/-4.5ml/kg/min (75+/-25% RV) Fifty-one% of patients achieved >400m in the ISWT (mean shuttle walk distance 392 +/-97 m).
There was a significant correlation between shuttle walk distance and peak VO2 (r=0.64, p <0.001). The overall diagnostic agreement between both algorithms was 70.7% (Kappa 0.50; McNemar-Bowker p <0.001).
For the assessment of “high risk” both algorithms matched in 100%. Twelve patients (29%) were classified as “low risk” according to the ACCP and as “moderate risk” by the ERS/ESTS.
Conclusions: Including ISWT performance in the ACCP* algorithm allows it to classify “high risk patients” in the same way as ERS / ESTS**.
However, ACCP overestimates the ”up to pneumonectomy" surgery recommendation in those patients whose CPET would have not have allowed it according to the ERS/ESTS.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA1123.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019