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
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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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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1 March 2024
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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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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