Implementation of Brief Submaximal Cardiopulmonary Testing in a High-Volume Presurgical Evaluation Clinic: Feasibility Cohort Study (Preprint)
Authors: Carr Zyad James , Agarkov Daniel , Li Judy , Charchaflieh Jean , Brenes-Bastos Andres , Freund Jonah , Zafar Jill , Schonberger Robert B , Heerdt Paul 
Published: February 2025

BACKGROUND

Precise functional capacity assessment is a critical component for preoperative risk stratification. Brief submaximal cardiopulmonary exercise testing (smCPET) has shown diagnostic utility in various cardiopulmonary conditions.

OBJECTIVE

This study aims to determine if smCPET could be implemented in a high-volume presurgical evaluation clinic and, when compared to structured functional capacity surveys, if smCPET could better discriminate low functional capacity (≤4.6 metabolic equivalents [METs]).

METHODS

After institutional approval, 43 participants presenting for noncardiac surgery who met the following inclusion criteria were enrolled: aged 60 years and older, a Revised Cardiac Risk Index of ≤2, and self-reported METs of ≥4.6 (self-endorsed ability to climb 2 flights of stairs). Subjective METs assessments, Duke Activity Status Index (DASI) surveys, and a 6-minute smCPET trial were conducted. The primary end points were (1) operational efficiency, based on the time of the experimental session being ≤20 minutes; (2) modified Borg survey of perceived exertion, with a score of ≤7 indicating no more than moderate exertion; (3) high participant satisfaction with smCPET task execution, represented as a score of ≥8 (out of 10); and (4) high participant satisfaction with smCPET scheduling, represented as a score of ≥8 (out of 10). Student's <i>t</i> test was used to determine the significance of the secondary end points. Correlation between comparable structured surveys and smCPET measurements was assessed using the Pearson correlation coefficient. A Bland-Altman analysis was used to assess agreement between the methods.

RESULTS

The mean session time was 16.9 (SD 6.8) minutes. The mean posttest modified Borg survey score was 5.35 (SD 1.8). The median patient satisfaction (on a scale of 1=worst to 10=best) was 10 (IQR 10-10) for scheduling and 10 (IQR 9-10) for task execution. Subjective METs were higher when compared to smCPET equivalents (extrapolated peak METs; mean 7.6, SD 2.0 vs mean 6.7, SD 1.8; <i>t</i><sub>42</sub>=2.1; <i>P</i>&lt;.001). DASI-estimated peak METs were higher when compared to smCPET peak METs (mean 8.8, SD 1.2 vs mean 6.7, SD 1.8; <i>t</i><sub>42</sub>=7.2; <i>P</i>&lt;.001). DASI-estimated peak oxygen uptake was higher than smCPET peak oxygen uptake (mean 30.9, SD 4.3 mL kg<sup>–1</sup> min<sup>–1</sup> vs mean 23.6, SD 6.5 mL kg<sup>–1</sup> min<sup>–1</sup>; <i>t</i><sub>42</sub>=7.2; <i>P</i>&lt;.001).

CONCLUSIONS

Implementation of smCPET in a presurgical evaluation clinic is both patient centered and clinically feasible. Brief smCPET measures, supportive of published reports regarding low sensitivity of provider-driven or structured survey measures for low functional capacity, were lower than those from structured surveys. Future studies will analyze the prediction of perioperative complications and cost-effectiveness.

CLINICALTRIAL

ClinicalTrials.gov NCT05743673; https://clinicaltrials.gov/study/NCT05743673