Preoperative cardiopulmonary exercise testing

2021 ◽  
pp. 133-137
Author(s):  
William J.M. Kinnear ◽  
James H. Hull
Keyword(s):  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Exercise Test ◽  
Surgical Planning ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Good Outcome ◽  
Clinical Problems

This chapter discusses how the results of a cardiopulmonary exercise test (CPET) can be used for preoperative surgical planning. A low preoperative maximum oxygen uptake (VO2max) is associated with a poor outcome. The lower the VO2max, the worse the prognosis. Use of the anaerobic threshold is less reliable. The CPET may identify clinical problems which can be optimized prior to surgery. Pre-habilitation can improve the chances of a good outcome from surgery.

Do rebreathing manoeuvres for non-invasive measurement of cardiac output during maximum exercise test alter the main cardiopulmonary parameters?

2019 ◽  
Vol 26 (15) ◽  
pp. 1616-1622 ◽  
Author(s):  
Carlo Vignati ◽  
Marco Morosin ◽  
Laura Fusini ◽  
Beatrice Pezzuto ◽  
Emanuele Spadafora ◽  
...  
Keyword(s):  
New York ◽  
Cardiac Output ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Testing ◽  
Heart Association ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise

Background Inert gas rebreathing has been recently described as an emergent reliable non-invasive method for cardiac output determination during exercise, allowing a relevant improvement of cardiopulmonary exercise test clinical relevance. For cardiac output measurements by inert gas rebreathing, specific respiratory manoeuvres are needed which might affect pivotal cardiopulmonary exercise test parameters, such as exercise tolerance, oxygen uptake and ventilation vs carbon dioxide output (VE/VCO2) relationship slope. Method We retrospectively analysed cardiopulmonary exercise testing of 181 heart failure patients who underwent both cardiopulmonary exercise testing and cardiopulmonary exercise test+cardiac output within two months (average 16 ± 15 days). All patients were in stable clinical conditions (New York Heart Association I–III) and on optimal medical therapy. Results The majority of patients were in New York Heart Association Class I and II (78.8%), with a mean left ventricular ejection fraction of 31 ± 10%. No difference was found between the two tests in oxygen uptake at peak exercise (1101 (interquartile range 870–1418) ml/min at cardiopulmonary exercise test vs 1103 (844–1389) at cardiopulmonary exercise test-cardiac output) and at anaerobic threshold. However, anaerobic threshold and peak heart rate, peak workload (75 (58–101) watts and 64 (42–90), p < 0.01) and carbon dioxide output were significantly higher at cardiopulmonary exercise testing than at cardiopulmonary exercise test+cardiac output, whereas VE/VCO2 slope was higher at cardiopulmonary exercise test+cardiac output (30 (27–35) vs 33 (28–37), p < 0.01). Conclusion The similar anaerobic threshold and peak oxygen uptake in the two tests with a lower peak workload and higher VE/VCO2 slope at cardiopulmonary exercise test+cardiac output suggest a higher respiratory work and consequent demand for respiratory muscle blood flow secondary to the ventilatory manoeuvres. Accordingly, VE/VCO2 slope and peak workload must be evaluated with caution during cardiopulmonary exercise test+cardiac output.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
Richard Davies ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 males) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R = 0.57 (CI 0.29–0.76), R = 0.59 (CI 0.31–0.77) and R = 0.62 (CI 0.35–0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01–0.64), R = 0.39 (CI 0.04–0.66) and R = 0.42 (CI 0.07–0.68) respectively) and peak work (R = 0.56 (CI 0.27–0.75), R = 0.48 (CI 0.17–0.70) and R = 0.50 (CI 0.2–0.72) respectively). Receiver operator curve (ROC) analysis for direct and self-reported measures of 7-day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24 January 2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

PARAMETRES OF CARDIOPULMONARY EXERCISE TESTING IN PATIENTS WITH LUNG AND ESOPHAGUS CANCER ACCORDING TO THEIR GENDER AND AGE

2021 ◽  
pp. 1142-1149
Author(s):  
Д. В. Троцюк ◽  
Д. С. Медведев ◽  
А. Е. Чиков ◽  
З. А. Зарипова ◽  
К. Л. Козлов
Keyword(s):  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Normal Population ◽  
Cardiopulmonary Exercise Testing ◽  
Human Organism ◽  
Aged Patients ◽  
Esophagus Cancer ◽  
Cardiopulmonary Exercise ◽  
Normal Ranges

Использование кардиореспираторного нагрузочного тестирования у пациентов со злокачественными новообразованиями играет важную роль в оценке риска послеоперационных осложнений и формировании отдаленного прогноза, оптимизации реабилитационного процесса, что особенно актуально для больных старших возрастных групп, имеющих полиморбидную патологию. В статье представлены результаты анализа кардиореспираторного нагрузочного тестирования у 362 пациентов различного возраста с онкологическими заболеваниями легких и пищевода, проведен сравнительный анализ аэробных возможностей у людей пожилого и старческого возраста и других возрастных групп. Средние значения анализируемых показателей покоя были выше, чем в популяции, при достижении анаэробного порога наблюдали обратную закономерность. Наиболее высокие показатели аэробного обмена были выявлены у пациентов 40-49 лет. Наблюдался ожидаемо более низкий уровень относительного потребления кислорода при достижении анаэробного порога у больных пожилого и старческого возраста по сравнению с более молодыми пациентами. Уровень пикового потребления кислорода у женщин всех возрастных групп был выше по сравнению с мужчинами; у пациентов старшего возраста регистрировали лучшие значения в процентном соотношении с нормой. Cardiopulmonary exercise testing is a diagnostic method, which can be used for oncological patients. It shows its perspectives in measuring reserve capacity of the human organism, determining the risk of postoperative complications, and long-term prognosis. The method is also useful for optimization of rehabilitation measures, which is actual for polymorbid aged patients. In this article we present data of cardiopulmonary exercise testing of 362 patients, men and women of different ages with lung and esophagus cancer. We performed a comparative analysis of aerobic ability of gerontological patients and patients from the other age groups. The patients showed higher ranges at rest in comparison to normal population, and lower rates on anaerobic threshold. Patients from the 40-49 age group showed the best values of aerobic exchange. Aged patients had lower oxygen uptake on anaerobic threshold than other groups. Women of all ages had higher values of peak oxygen uptake then men; aged patients showed better results in comparison to the normal ranges.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2021 ◽  
Author(s):  
Matt Morgan ◽  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery.Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices.Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 male) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R=0.57 (CI 0.29-0.76), R=0.59 (CI 0.31-0.77) and R=0.62 (CI 0.35-0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01-0.64), R = 0.39 (CI 0.04-0.66) and R = 0.42 (CI 0.07-0.68) respectively) and peak work (R = 0.56 (CI 0.27-0.75), R = 0.48 (CI 0.17-0.70) and R = 0.50 (CI 0.2-0.72) respectively).Receiver Operator Curve (ROC) analysis for direct and self-reported measures of 7 day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work.Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment.Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24/1/2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

Anaerobic threshold

2021 ◽  
pp. 86-92
Author(s):  
William J.M. Kinnear ◽  
James H. Hull
Keyword(s):  
Carbon Dioxide ◽  
Heart Disease ◽  
Lactic Acid ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Operative Risk ◽  
Anaerobic Processes ◽  
Cardiopulmonary Exercise

This chapter describes the changes that occur when anaerobic processes start to supplement aerobic metabolism during a cardiopulmonary exercise test (CPET). Lactic acid is produced, which is buffered by bicarbonate to produce carbon dioxide and water. The anaerobic threshold (AT) should be seen when VO2 is at least 40% of predicted maximum oxygen uptake (VO2max). A low AT indicates poor oxygen delivery to muscles. This can be seen in heart disease, peripheral vascular disease or anaemia. AT is useful for predicting operative risk.

scholarly journals Estimating pVO2 and prognosis through cardiac exercise stress test in a heart failure population

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.P.L De Almeida ◽  
J Milner ◽  
J Rosa ◽  
R Coutinho ◽  
M Ferreira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Testing ◽  
Exercise Test ◽  
Stress Test ◽  
Pearson Correlation ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Stress Test ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Stress ◽  
Cardiopulmonary Exercise

Abstract Background Compared with the cardiac exercise stress test, more commonly used to assess the presence of ischemia, the cardiopulmonary exercise test has the advantage of providing expired gas analysis. According to current guidelines, cardiopulmonary exercise testing should be considered to stratify the risk of adverse events and to provide measures of survival improvement in heart failure populations. However, cardiac exercise stress test is more readily available and widespread than cardiopulmonary exercise testing. We aimed to compare prognostic information given by estimated pVO2 – which can be obtained from cardiac exercise stress test – and real measured pVO2 – which requires cardiopulmonary exercise test – in a heart failure population. Methods We conducted a retrospective analysis of 214 patients with HF underwent cardiac exercise stress test and accessed their 5 year survival. Non-urgent transplanted (UNOS Status 2) patients were censored alive on the date of the transplant. Duringthe cardiopulmonary exercise test, cardiac exercise stress test data simultaneously collected. Based on protocol stage achieved, estimated METs were used to calculate estimated pVO2 (pVO2 = estimated METs x 3.5). Estimated and real pVO2 were correlated using Pearson correlation and the age-adjusted prognostic power of each was determined using Cox proportional hazardsanalysis. Results 164 patients were male (77%) and the mean age of the population was 56±10 years. 78 (36%) patients had an ischemic etiology. Within 5 years from testing, 46 patients died (21.5%) and 55 patients (26%) were transplanted. Naughton modified (n=165) was the most commonly used protocol, followed by Naughton (n=39) and Bruce (n=10). Estimated pVO2 and measured pVO2 correlated significantly (R=0.66, p&lt;0.01) (Figure 1). Both estimated (HR=0.91, 95% CI 0.86–0.95, p&lt;0.01) and measured pVO2 (HR=0.86, 95% CI 0.80–0.91, p&lt;0.01) strongly predicted prognosis in this population. Conclusions Estimated pVO2 correlated with measured pVO2 and strongly predicted prognosis in this heart failure population. Because it can be obtained from conventional cardiac exercise testing, it may become an alternative prognostic tool to cardiopulmonary testing. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Measured vs estimated pVO2

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2021 ◽  
Author(s):  
Matt Morgan ◽  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices.Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 male) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R=0.57 (CI 0.29-0.76), R=0.59 (CI 0.31-0.77) and R=0.62 (CI 0.35-0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01-0.64), R = 0.39 (CI 0.04-0.66) and R = 0.42 (CI 0.07-0.68) respectively) and peak work (R = 0.56 (CI 0.27-0.75), R = 0.48 (CI 0.17-0.70) and R = 0.50 (CI 0.2-0.72) respectively). Receiver Operator Curve (ROC) analysis for direct and self-reported measures of 7 day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24/1/2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

scholarly journals Ventilatory compensation during the incremental exercise test is inversely correlated with air trapping in COPD

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 1661
Author(s):  
Rottem Kuint ◽  
Neville Berkman ◽  
Samir Nusair
Keyword(s):  
Gas Exchange ◽  
Exercise Testing ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Testing ◽  
Incremental Exercise ◽  
Peak Exercise ◽  
Air Trapping ◽  
Incremental Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Copd Patients

Background: Air trapping and gas exchange abnormalities are major causes of exercise limitation in chronic obstructive pulmonary disease (COPD). During incremental cardiopulmonary exercise testing, actual nadir values of ventilatory equivalents for carbon dioxide (V E/VCO 2) and oxygen (V E/VO 2) may be difficult to identify in COPD patients because of limited ventilatory compensation capacity. Therefore, we aimed in this exploratory study to detect a possible correlation between the magnitude of ventilation augmentation, as manifested by increments in ventilatory equivalents from nadir to peak exercise values and air trapping, detected with static testing.    Methods: In this observational study, we studied data obtained previously from 20 COPD patients who, during routine follow-up, underwent a symptom-limited incremental exercise test and in whom a plethysmography was obtained concurrently. Air trapping at rest was assessed by measurement of the residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC). Gas exchange data collected during the symptom-limited incremental cardiopulmonary exercise test allowed determination of the nadir and peak exercise values of V E/VCO 2 and V E/VO 2, thus enabling calculation of the difference between peak exrcise value and nadir values of  V E/VCO 2 and V E/VO 2, designated ΔV E/VCO 2 and ΔV E/VO 2, respectively. Results: We found a statistically significant inverse correlation between both ΔV E/VCO 2 (r = -0. 5058, 95% CI -0.7750 to -0.08149, p = 0.0234) and ΔV E/VO 2 (r = -0.5588, 95% CI -0.8029 to -0.1545, p = 0.0104) and the degree of air trapping (RV/TLC). There was no correlation between ΔV E/VCO 2 and forced expiratory volume in the first second, or body mass index.  Conclusions: The ventilatory equivalents increment to compensate for acidosis during incremental exercise testing was inversely correlated with air trapping (RV/TLC).

scholarly journals Ventilatory compensation during the incremental exercise test is inversely correlated with air trapping in COPD

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1661
Author(s):  
Rottem Kuint ◽  
Neville Berkman ◽  
Samir Nusair
Keyword(s):  
Gas Exchange ◽  
Exercise Testing ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Testing ◽  
Incremental Exercise ◽  
Peak Oxygen Consumption ◽  
Air Trapping ◽  
Incremental Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Copd Patients

Background: Air trapping and gas exchange abnormalities are major causes of exercise limitation in chronic obstructive pulmonary disease (COPD). During incremental cardiopulmonary exercise testing, ventilatory equivalents for carbon dioxide (VE/VCO2) and oxygen (VE/VO2) may be difficult to identify in COPD patients because of limited ventilatory compensation capacity. Therefore, we aimed to detect a possible correlation between the magnitude of ventilation augmentation, as manifested by increments in ventilatory equivalents from nadir to peak effort values and air trapping, detected with static testing.    Methods: In this observational study, we studied data obtained previously from 20 COPD patients who, during routine follow-up, underwent a symptom-limited incremental exercise test and in whom a plethysmography was obtained concurrently. Air trapping at rest was assessed by measurement of the residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC). Gas exchange data collected during the symptom-limited incremental cardiopulmonary exercise test allowed determination of the nadir and peak effort values of VE/VCO2 and VE/VO2, thus enabling calculation of the difference between peak effort value and nadir values of  VE/VCO2 and VE/VO2, designated ΔVE/VCO2 and ΔVE/VO2, respectively. Results: We found a statistically significant inverse correlation between both ΔVE/VCO2 (r = -0. 5058, 95% CI -0.7750 to -0.08149, p = 0.0234) and ΔVE/VO2 (r = -0.5588, 95% CI -0.8029 to -0.1545, p = 0.0104) and the degree of air trapping (RV/TLC). There was no correlation between                ΔVE/VCO2 and peak oxygen consumption, forced expiratory volume in the first second, or body mass index.  Conclusions: The ventilatory equivalents increment to compensate for acidosis during incremental exercise testing was inversely correlated with air trapping (RV/TLC) and may be a candidate prognostic biomarker.

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