Multivariate Criteria Most Accurately Distinguish Cardiac from Noncardiac Causes of Dyspnea. Tex Heart Inst J 2015 Dec;42(6):514-21
Date
12/15/2015Pubmed ID
26664302Pubmed Central ID
PMC4665276DOI
10.14503/THIJ-14-4373Scopus ID
2-s2.0-84949226840 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
Cardiopulmonary exercise testing provides oxygen pulse as a continuous measure of stroke volume, which is superior to other stress-testing methods in which systolic function is measured at baseline and at peak stress. However, the optimal peak oxygen pulse criterion for distinguishing cardiac from noncardiac causes of exercise limitation is unknown. In comparing several peak oxygen pulse criteria against the clinical standard of cardiopulmonary exercise testing, we retrospectively studied 54 consecutive patients referred for cardiopulmonary exercise testing. These exercise tests included measurement of oxygen consumption, carbon dioxide production, breathing reserve, arterial blood gases at baseline and at peak stress, exercise electrocardiogram, heart rate, and blood pressure response. Results were blindly interpreted and patients were categorized as members either of our Cardiac Group (abnormal result secondary to cardiac causes of exercise limitation) or of our Noncardiac Group (normal or abnormal result secondary to any noncardiac cause of exercise limitation). The accuracy of the peak oxygen pulse criteria ranged from 50% for univariate criterion (≤15 mL/beat), to 61% for oxygen pulse curve pattern, to 63% for bivariate criterion (≤15 mL/beat for men, ≤10 mL/beat for women), to as high as 81% for a multivariate criterion. All multivariate criteria outperformed oxygen pulse curve pattern, univariate, and bivariate criteria. This is the first study to evaluate the optimal peak oxygen pulse criterion for differentiating cardiac from noncardiac causes of exercise limitation. Multivariate criteria (especially a criterion incorporating age, sex, height, and weight) should be used preferentially, as opposed to the commonly used univariate and bivariate criteria.
Author List
Ahmad MN, Yusuf SH, Ullah R, Ahmad MM, Ellis MK, Yousaf H, Paterick TE, Ammar KAMESH terms used to index this publication - Major topics in bold
AdultAge Factors
Aged
Blood Gas Analysis
Blood Pressure
Body Height
Body Weight
Dyspnea
Electrocardiography
Exercise Test
Female
Heart Diseases
Heart Rate
Humans
Male
Middle Aged
Models, Biological
Multivariate Analysis
Oxygen Consumption
Predictive Value of Tests
Reproducibility of Results
Respiration
Retrospective Studies
Risk Factors
Sex Factors
Stroke Volume
