Defining reference intervals for submaximal cardiopulmonary exercise testing-derived gas-exchange derived pulmonary capacitance in older adults

IF 1.7 4区医学 Q4 PHYSIOLOGY

Clinical Physiology and Functional Imaging Pub Date : 2026-06-24 DOI:10.1111/cpf.70076

Yoshio Tatsuoka, Megan Longley, Dean MacCarter, Zyad J. Carr

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引用次数: 0

Abstract

Background

Gas-exchange derived pulmonary capacitance (GXCAP) is a non-invasive index of pulmonary arterial capacitance obtainable from submaximal cardiopulmonary exercise testing (CPET), but reference intervals in older adults, a key target population, are lacking.

Methods

A secondary analysis of an open-label clinical device trial, including 207 adults ≥ 60 years undergoing elective non-cardiac surgery was performed. Submaximal CPET with the Shape II system provided peak GXCAP, GXCAP–time slope, and GXCAP–VO₂ slope. Sex-specific empirical 95% reference intervals (2.5th–97.5th percentiles) and indirect reference intervals were calculated using the refineR algorithm, which models the latent healthy subpopulation within routine data. Associations with age and sex were examined using correlation and group comparisons.

Results

The analytic cohort comprised 207 nonsmoking participants (119 males, 88 females). Males demonstrated higher peak GXCAP and steeper GXCAP–time and GXCAP–VO₂ slopes than females. Age was modestly and inversely associated with peak GXCAP and GXCAP–time slope. Empirical reference intervals were wide and right-skewed, whereas refineR produced narrower, physiologically plausible intervals, for example, peak GXCAP 144.9–810.0 mL.mmHg (overall), with higher upper limits in males.

Conclusions

In older adults undergoing preoperative evaluation, GXCAP metrics show clear sex differences. Indirect, refineR-based, reference intervals provide stable, clinically interpretable ranges that may enhance the use of GXCAP for noninvasively assessing pulmonary arterial capacitance in submaximal CPET. GXCAP derivatives (GXCAP–time slope and GXCAP–VO₂ slope were introduced and may offer distinct advantages in submaximal cardiopulmonary exercise testing.

Clinical Trial Registration

NCT05743673, Principal Investigator: Zyad J. Carr, M.D.

查看原文本刊更多论文

确定次最大心肺运动试验的参考区间——老年人气体交换衍生肺电容。

背景：气体交换衍生肺电容（GXCAP）是一种可从亚最大心肺运动试验（CPET）中获得的无创肺动脉电容指标，但在老年人这一关键目标人群中缺乏参考区间。方法：对一项开放标签临床器械试验进行二次分析，该试验包括207名≥60岁的接受选择性非心脏手术的成年人。形状II体系的次极大CPET提供峰值GXCAP、GXCAP时间斜率和GXCAP- vo2斜率。使用refineR算法计算性别特异性经验95%参考区间（2.5 -97.5百分位数）和间接参考区间，该算法在常规数据中模拟潜在健康亚群。通过相关性和分组比较，研究了年龄和性别之间的关系。结果：分析队列包括207名不吸烟参与者（119名男性，88名女性）。雄性比雌性表现出更高的GXCAP峰值、更陡峭的GXCAP时间和GXCAP- vo2斜率。年龄与GXCAP峰值和GXCAP时间斜率呈适度负相关。经验参考区间宽且右偏，而refineR产生的区间更窄，生理上合理，例如，峰值GXCAP 144.9-810.0 mL.mmHg（总体），男性的上限更高。结论：在接受术前评估的老年人中，GXCAP指标显示出明显的性别差异。间接的、基于细化的参考区间提供了稳定的、临床可解释的范围，可以增强GXCAP在亚最大值CPET中无创评估肺动脉电容的应用。GXCAP衍生物（GXCAP-time slope和GXCAP- vo2 slope）在亚极限心肺运动测试中具有明显的优势。临床试验注册：NCT05743673，首席研究员：Zyad J. Carr， M.D.

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来源期刊

Clinical Physiology and Functional Imaging 医学-生理学

CiteScore

3.40

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical Physiology and Functional Imaging publishes reports on clinical and experimental research pertinent to human physiology in health and disease. The scope of the Journal is very broad, covering all aspects of the regulatory system in the cardiovascular, renal and pulmonary systems with special emphasis on methodological aspects. The focus for the journal is, however, work that has potential clinical relevance. The Journal also features review articles on recent front-line research within these fields of interest. Covered by the major abstracting services including Current Contents and Science Citation Index, Clinical Physiology and Functional Imaging plays an important role in providing effective and productive communication among clinical physiologists world-wide.