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

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

doi:10.1513/AnnalsATS.202304-317OC

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

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

Research output: Contribution to journal › Article › peer-review

52 Downloads (Pure)

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 percent predicted peak oxygen uptake (V ̇O_2peak) and peak work rate (W_peak) as significant predictors of death/LTX: adjusted hazard ratios per each additional ten percent 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 twelve prognostic factors for survival, identified W_peak 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 W_peak >49.2% predicted, P<0.001.

Conclusions: CPET provides prognostic information in ACFLD and Wpeak appears to be a promising marker for LTX referral and candidate selection.

Original language	English
Pages (from-to)	411-420
Journal	Annals of the American Thoracic Society
Volume	21
Issue number	3
Early online date	25 Oct 2023
DOIs	https://doi.org/10.1513/AnnalsATS.202304-317OC
Publication status	Published - 1 Mar 2024

Access to Document

10.1513/AnnalsATS.202304-317OC

Cardiopulmonary Exercise Testing Provides PublishedFinal published version, 933 KBLicence: CC BY-NC-ND

Cite this

Radtke, T., Urquhart, D. S., Braun, J., Barry, P. J., Waller, I., Petch, N., Mei-Zahav, M., Kramer, M. R., Hua-Huy, T., Dinh-Xuan, A. T., Innes, J. A., McArthur, S., Sovtic, A., Gojsina, B., Verges, S., De Maat, T., Morrison, L., Wood, J., Crute, S., ... Hebestreit, H. (2024). Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease. Annals of the American Thoracic Society, 21(3), 411-420. https://doi.org/10.1513/AnnalsATS.202304-317OC

@article{fc73ae94a6c54e158af770dfa28ac988,

title = "Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease",

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 percent predicted peak oxygen uptake (V{\. }O2peak) and peak work rate (Wpeak) as significant predictors of death/LTX: adjusted hazard ratios per each additional ten percent 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 twelve 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 ACFLD and Wpeak appears to be a promising marker for LTX referral and candidate selection.",

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

note = "WNU",

year = "2024",

month = mar,

day = "1",

doi = "10.1513/AnnalsATS.202304-317OC",

language = "English",

volume = "21",

pages = "411--420",

journal = "Annals of the American Thoracic Society",

issn = "2329-6933",

publisher = "American Thoracic Society",

number = "3",

}

Radtke, T, Urquhart, DS, Braun, J, Barry, PJ, Waller, I, Petch, N, Mei-Zahav, M, Kramer, MR, Hua-Huy, T, Dinh-Xuan, AT, Innes, JA, McArthur, S, Sovtic, A, Gojsina, B, Verges, S, De Maat, T, Morrison, L, Wood, J, Crute, S, Williams, CA, Tomlinson, OW, Bar-Yoseph, R, Hebestreit, A, Quon, BS, Kwong, E, Saynor, ZL, Causer, AJ, Stephenson, AL, Schneiderman, JE, Shaw, M, Dwyer, T, Stevens, D, Remus, N, Douvry, B, Foster, K, Benden, C, Ratjen, F & Hebestreit, H 2024, 'Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease', Annals of the American Thoracic Society, vol. 21, no. 3, pp. 411-420. https://doi.org/10.1513/AnnalsATS.202304-317OC

TY - JOUR

T1 - Cardiopulmonary exercise testing provides prognostic information in advanced cystic fibrosis lung disease

AU - Radtke, Thomas

AU - Urquhart, Don S.

AU - Braun, Julia

AU - Barry, Peter J.

AU - Waller, Ian

AU - Petch, Nicole

AU - Mei-Zahav, Meir

AU - Kramer, Mordechai R.

AU - Hua-Huy, Thong

AU - Dinh-Xuan, Anh Tuan

AU - Innes, J. Alastair

AU - McArthur, Sara

AU - Sovtic, Aleksandar

AU - Gojsina, Bojana

AU - Verges, Samuel

AU - De Maat, Tanguy

AU - Morrison, Lisa

AU - Wood, Jamie

AU - Crute, Samantha

AU - Williams, Craig A.

AU - Tomlinson, Owen W.

AU - Bar-Yoseph, Ronen

AU - Hebestreit, Alexandra

AU - Quon, Bradley S.

AU - Kwong, Eugenie

AU - Saynor, Zoe L.

AU - Causer, Adam J.

AU - Stephenson, Anne L.

AU - Schneiderman, Jane E.

AU - Shaw, Michelle

AU - Dwyer, Tiffany

AU - Stevens, Daniel

AU - Remus, Natascha

AU - Douvry, Benoit

AU - Foster, Karla

AU - Benden, Christian

AU - Ratjen, Felix

AU - Hebestreit, Helge

N1 - WNU

PY - 2024/3/1

Y1 - 2024/3/1

N2 - 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 percent predicted peak oxygen uptake (V ̇O2peak) and peak work rate (Wpeak) as significant predictors of death/LTX: adjusted hazard ratios per each additional ten percent 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 twelve 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 ACFLD and Wpeak appears to be a promising marker for LTX referral and candidate selection.

AB - 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 percent predicted peak oxygen uptake (V ̇O2peak) and peak work rate (Wpeak) as significant predictors of death/LTX: adjusted hazard ratios per each additional ten percent 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 twelve 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 ACFLD and Wpeak appears to be a promising marker for LTX referral and candidate selection.

UR - https://www.atsjournals.org/doi/10.1513/AnnalsATS.202304-317OC

U2 - 10.1513/AnnalsATS.202304-317OC

DO - 10.1513/AnnalsATS.202304-317OC

M3 - Article

SN - 2329-6933

VL - 21

SP - 411

EP - 420

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

IS - 3

ER -

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

Abstract

Access to Document

Fingerprint

Cite this