| Cardiopulmonary exercise test in patients with subacute pulmonary emboli. | |
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MedLine Citation:
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PMID: 21893343 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Yan Topilsky; Courtney L Hayes; Amber D Khanna; Thomas G Allison |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-3 |
Journal Detail:
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Title: Heart & lung : the journal of critical care Volume: - ISSN: 1527-3288 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-6 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0330057 Medline TA: Heart Lung Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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