Open AccessUtility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients
Author(s) -
Petek Bradley J.,
Churchill Timothy W.,
Sawalla Guseh J.,
Loomer Garrett,
Gustus Sarah K.,
Lewis Gregory D.,
Weiner Rory B.,
Baggish Aaron L.,
Wasfy Meagan M.
Publication year - 2021
Publication title -
physiological reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 39
ISSN - 2051-817X
DOI - 10.14814/phy2.15105
Subject(s) - medicine , coronary artery disease , cardiology , oxygen pulse , plateau (mathematics) , pulse (music) , area under the curve , coronary angiography , vo2 max , heart rate , blood pressure , myocardial infarction , mathematical analysis , mathematics , detector , electrical engineering , engineering
Cardiopulmonary exercise testing (CPET) guidelines recommend analysis of the oxygen (O 2 ) pulse for a late exercise plateau in evaluation for obstructive coronary artery disease (OCAD). However, whether this O 2 pulse trajectory is within the range of normal has been debated, and the diagnostic performance of the O 2 pulse for OCAD in physically fit individuals, in whomV ˙ O 2may be more likely to plateau, has not been evaluated. Using prospectively collected data from a sports cardiology program, patients were identified who were free of other cardiac disease and underwent clinically‐indicated CPET within 90 days of invasive or computed tomography coronary angiography. The diagnostic performance of quantitative O 2 pulse metrics (late exercise slope, proportional change in slope during late exercise) and qualitative assessment for O 2 pulse plateau to predict OCAD was assessed. Among 104 patients (age:56 ± 12 years, 30% female, peakV ˙ O 2119 ± 34% predicted), the diagnostic performance for OCAD (n = 24,23%) was poor for both quantitative and qualitative metrics reflecting an O 2 pulse plateau (late exercise slope: AUC = 0.55, sensitivity = 68%, specificity = 41%; proportional change in slope: AUC = 0.55, sensitivity = 91%, specificity = 18%; visual plateau/decline: AUC = 0.51, sensitivity = 33%, specificity = 67%). When O 2 pulse parameters were added to the electrocardiogram, the change in AUC was minimal (−0.01 to +0.02, p ≥ 0.05). Those patients without OCAD with a plateau or decline in O 2 pulse were fitter than those with linear augmentation (peakV ˙ O 2133 ± 31% vs. 114 ± 36% predicted, p < 0.05) and had a longer exercise ramp time (9.5 ± 3.2 vs. 8.0 ± 2.5 min, p < 0.05). Overall, a plateau in O 2 pulse was not a useful predictor of OCAD in a physically fit population, indicating that the O 2 pulse should be integrated with other CPET parameters and may reflect a physiologic limitation of stroke volume and/or O 2 extraction during intense exercise.