BACKGROUND Cardiopulmonary exercise testing (CPET) identifies high-risk patients before major surgery. In addition to using oxygen uptake and ventilatory efficiency to assess functional capacity, CPET can be used to identify underlying myocardial dysfunction through the assessment of the oxygen uptake to heart rate response (oxygen pulse response). We examined the relationship of oxygen pulse response, in combination with other CPET variables and known cardiac risk factors, with mortality after colorectal cancer surgery. METHODS This work focused on a retrospective cohort study of patients who had CPET and underwent colorectal cancer surgery. The primary outcome was a composite of in-hospital and 30-day mortality. Ventilatory inefficiency (Ve/Vco2>34) and exercise-induced myocardial dysfunction (abnormal oxygen pulse response) were investigated for an association with mortality using bivariable analysis and multivariable Cox regression. RESULTS A total of 1214 patients who underwent colorectal cancer surgery were included, and the primary outcome occurred in 26 patients (2.1%). Multivariable Cox regression showed abnormal oxygen pulse response was independently associated with the primary outcome (odds ratio [OR]=2.75; 95% confidence interval [CI], 1.17-6.47). Bivariable analysis showed that Ve/Vco2 >34 was associated with the primary outcome (OR=3.43; 95% CI, 1.47-8.01). Combining Ve/Vco2 >34 and abnormal oxygen pulse response conferred an increased risk for the primary outcome (OR=4.47; 95% CI, 1.62-12.34), compared with Ve/Vco2 >34 and normal oxygen pulse response. CONCLUSION Ventilatory inefficiency and an abnormal oxygen pulse response were independently associated with short- (30-day) and long-term (2-yr) mortality. Oxygen pulse response may provide additional information when considering perioperative risk stratification.

中文翻译：

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通过心肺运动测试检测到的运动诱发的心肌功能障碍与大型肿瘤学结直肠手术中死亡的风险增加相关。

背景技术心肺运动测试（CPET）可以识别大手术之前的高危患者。除了使用摄氧量和通气效率来评估功能能力外，CPET还可以通过评估对心率反应（氧脉冲反应）的摄氧量来识别潜在的心肌功能障碍。我们检查了氧脉冲反应，其他CPET变量和已知的心脏危险因素与结直肠癌手术后死亡率的关系。方法这项工作集中于一项回顾性队列研究，研究对象为患有CPET并接受了结直肠癌手术的患者。主要结局是院内死亡率和30天死亡率的综合结果。通气效率低下（Ve / Vco2> 使用双变量分析和多变量Cox回归分析了运动引起的心肌功能障碍（异常的氧气脉冲响应）与死亡率之间的关系（图34）。结果共纳入了1214例接受了结直肠癌手术的患者，主要结局发生在26例患者中（2.1％）。多变量Cox回归显示异常氧脉冲反应与主要预后独立相关（优势比[OR] = 2.75； 95％置信区间[CI]，1.17-6.47）。双变量分析显示，Ve / Vco2> 34与主要结局相关（OR = 3.43； 95％CI，1.47-8.01）。与Ve / Vco2> 34和正常氧脉冲反应相比，将Ve / Vco2> 34和异常氧脉冲反应相结合会增加主要结果的风险（OR = 4.47； 95％CI，1.62-12.34）。结论通气效率低下和氧气脉冲反应异常与短期（30天）和长期（2年）死亡率相关。考虑围手术期风险分层时，氧气脉冲响应可能会提供其他信息。