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Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease

Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease
Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease
Rationale: cardiopulmonary exercise testing (CPET) provides prognostic information in cystic fibrosis (CF); however, its prognostic value for patients with advanced CF lung disease (ACFLD) is unknown.

Objectives: to determine the prognostic value of CPET on the risk of death or lung transplant (LTX) within 2-years.

Methods: we retrospectively collected data from 20 CF centers in Asia, Australia, Europe, and North America on patients with a forced expiratory volume in 1s (FEV1) ≤40% predicted who performed a cycle ergometer CPET between January 2008 and December 2017. Time to death/LTX was analyzed using mixed Cox proportional hazards regression. Conditional inference trees were modelled to identify subgroups with increased risk of death/LTX.

Results: In total, 174 patients (FEV1, 30.9% ± 5.8% predicted) were included. Forty-four patients (25.5%) died or underwent LTX. Cox regression analysis adjusted for age, sex, and FEV1 revealed percentage predicted peak oxygen uptake (Vo2peak) and peak work rate (Wpeak) as significant predictors of death/LTX: adjusted hazard ratios per each additional 10% predicted were 0.60 (95% confidence interval, 0.43–0.90; P = 0.008) and 0.60 (0.48–0.82; P < 0.001). Tree-structured regression models, including a set of 11 prognostic factors for survival, identified Wpeak to be most strongly associated with 2-year risk of death/LTX. Probability of death/LTX was 45.2% for those with a Wpeak ⩽ 49.2% predicted versus 10.9% for those with a Wpeak > 49.2% predicted (P < 0.001).

Conclusions: CPET provides prognostic information in advanced CF lung disease, and Wpeak appears to be a promising marker for LTX referral and candidate selection.
CF, lung transplantation, peak oxygen uptake, peak work rate, survival
2329-6933
411-420
Radtke, Thomas
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Urquhart, Don S.
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Braun, Julia
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Barry, Peter J.
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Waller, Ian
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Petch, Nicole
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Mei-Zahav, Meir
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Kramer, Mordechai R.
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Hua-Huy, Thong
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Dinh-Xuan, Anh Tuan
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Innes, J. Alastair
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McArthur, Sara
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Sovtic, Aleksandar
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Gojsina, Bojana
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Verges, Samuel
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De Maat, Tanguy
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Morrison, Lisa
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Wood, Jamie
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Crute, Samantha
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Williams, Craig A.
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Tomlinson, Owen W.
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Bar-Yoseph, Ronen
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Hebestreit, Alexandra
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Quon, Bradley S.
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Kwong, Eugenie
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Saynor, Zoe L.
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Causer, Adam J.
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Stephenson, Anne L.
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Schneiderman, Jane E.
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Shaw, Michelle
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Dwyer, Tiffany
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Stevens, Daniel
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Remus, Natascha
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Douvry, Benoit
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Foster, Karla
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Benden, Christian
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Ratjen, Felix
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Hebestreit, Helge
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Radtke, Thomas
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Urquhart, Don S.
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Braun, Julia
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Barry, Peter J.
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Waller, Ian
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Petch, Nicole
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Mei-Zahav, Meir
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Kramer, Mordechai R.
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Hua-Huy, Thong
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Dinh-Xuan, Anh Tuan
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Innes, J. Alastair
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McArthur, Sara
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Sovtic, Aleksandar
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Gojsina, Bojana
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Verges, Samuel
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De Maat, Tanguy
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Morrison, Lisa
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Wood, Jamie
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Crute, Samantha
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Williams, Craig A.
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Tomlinson, Owen W.
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Bar-Yoseph, Ronen
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Hebestreit, Alexandra
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Quon, Bradley S.
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Kwong, Eugenie
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Saynor, Zoe L.
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Causer, Adam J.
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Stephenson, Anne L.
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Schneiderman, Jane E.
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Shaw, Michelle
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Dwyer, Tiffany
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Stevens, Daniel
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Remus, Natascha
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Douvry, Benoit
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Foster, Karla
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Benden, Christian
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Ratjen, Felix
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Hebestreit, Helge
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Radtke, Thomas, Urquhart, Don S., Braun, Julia, Barry, Peter J., Waller, Ian, Petch, Nicole, Mei-Zahav, Meir, Kramer, Mordechai R., Hua-Huy, Thong, Dinh-Xuan, Anh Tuan, Innes, J. Alastair, McArthur, Sara, Sovtic, Aleksandar, Gojsina, Bojana, Verges, Samuel, De Maat, Tanguy, Morrison, Lisa, Wood, Jamie, Crute, Samantha, Williams, Craig A., Tomlinson, Owen W., Bar-Yoseph, Ronen, Hebestreit, Alexandra, Quon, Bradley S., Kwong, Eugenie, Saynor, Zoe L., Causer, Adam J., Stephenson, Anne L., Schneiderman, Jane E., Shaw, Michelle, Dwyer, Tiffany, Stevens, Daniel, Remus, Natascha, Douvry, Benoit, Foster, Karla, Benden, Christian, Ratjen, Felix and Hebestreit, Helge (2024) Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease. Annals of the American Thoracic Society, 21 (3), 411-420. (doi:10.1513/AnnalsATS.202304-317OC).

Record type: Article

Abstract

Rationale: cardiopulmonary exercise testing (CPET) provides prognostic information in cystic fibrosis (CF); however, its prognostic value for patients with advanced CF lung disease (ACFLD) is unknown.

Objectives: to determine the prognostic value of CPET on the risk of death or lung transplant (LTX) within 2-years.

Methods: we retrospectively collected data from 20 CF centers in Asia, Australia, Europe, and North America on patients with a forced expiratory volume in 1s (FEV1) ≤40% predicted who performed a cycle ergometer CPET between January 2008 and December 2017. Time to death/LTX was analyzed using mixed Cox proportional hazards regression. Conditional inference trees were modelled to identify subgroups with increased risk of death/LTX.

Results: In total, 174 patients (FEV1, 30.9% ± 5.8% predicted) were included. Forty-four patients (25.5%) died or underwent LTX. Cox regression analysis adjusted for age, sex, and FEV1 revealed percentage predicted peak oxygen uptake (Vo2peak) and peak work rate (Wpeak) as significant predictors of death/LTX: adjusted hazard ratios per each additional 10% predicted were 0.60 (95% confidence interval, 0.43–0.90; P = 0.008) and 0.60 (0.48–0.82; P < 0.001). Tree-structured regression models, including a set of 11 prognostic factors for survival, identified Wpeak to be most strongly associated with 2-year risk of death/LTX. Probability of death/LTX was 45.2% for those with a Wpeak ⩽ 49.2% predicted versus 10.9% for those with a Wpeak > 49.2% predicted (P < 0.001).

Conclusions: CPET provides prognostic information in advanced CF lung disease, and Wpeak appears to be a promising marker for LTX referral and candidate selection.

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radtke-et-al-2024-cardiopulmonary-exercise-testing-provides-prognostic-information-in-advanced-cystic-fibrosis-lung - Version of Record
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More information

Accepted/In Press date: 25 October 2023
Published date: 1 March 2024
Additional Information: WNU
Keywords: CF, lung transplantation, peak oxygen uptake, peak work rate, survival

Identifiers

Local EPrints ID: 493837
URI: http://eprints.soton.ac.uk/id/eprint/493837
ISSN: 2329-6933
PURE UUID: 8369c265-3a2e-4012-8c26-d31c1dca7fc0
ORCID for Zoe L. Saynor: ORCID iD orcid.org/0000-0003-0674-8477

Catalogue record

Date deposited: 13 Sep 2024 16:59
Last modified: 14 Sep 2024 02:13

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Contributors

Author: Thomas Radtke
Author: Don S. Urquhart
Author: Julia Braun
Author: Peter J. Barry
Author: Ian Waller
Author: Nicole Petch
Author: Meir Mei-Zahav
Author: Mordechai R. Kramer
Author: Thong Hua-Huy
Author: Anh Tuan Dinh-Xuan
Author: J. Alastair Innes
Author: Sara McArthur
Author: Aleksandar Sovtic
Author: Bojana Gojsina
Author: Samuel Verges
Author: Tanguy De Maat
Author: Lisa Morrison
Author: Jamie Wood
Author: Samantha Crute
Author: Craig A. Williams
Author: Owen W. Tomlinson
Author: Ronen Bar-Yoseph
Author: Alexandra Hebestreit
Author: Bradley S. Quon
Author: Eugenie Kwong
Author: Zoe L. Saynor ORCID iD
Author: Adam J. Causer
Author: Anne L. Stephenson
Author: Jane E. Schneiderman
Author: Michelle Shaw
Author: Tiffany Dwyer
Author: Daniel Stevens
Author: Natascha Remus
Author: Benoit Douvry
Author: Karla Foster
Author: Christian Benden
Author: Felix Ratjen
Author: Helge Hebestreit

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