Comparing four non-invasive methods to determine the ventilatory anaerobic threshold during cardiopulmonary exercise testing in children with congenital heart or lung disease.

Abstract

The ventilatory anaerobic threshold (VAT) is an important method to assess the aerobic fitness in patients with cardiopulmonary disease. Several methods exist to determine the VAT; however, there is no consensus which of these methods is the most accurate. To compare four different non-invasive methods for the determination of the VAT via respiratory gas exchange analysis during a cardiopulmonary exercise test (CPET). A secondary objective is to determine the interobserver reliability of the VAT. CPET data of 30 children diagnosed with either cystic fibrosis (CF; N = 15) or with a surgically corrected dextro-transposition of the great arteries (asoTGA; N = 15) were included. No significant differences were found between conditions or among testers. The RER = 1 method differed the most compared to the other methods, showing significant higher results in all six variables. The PET-O2 method differed significantly on five of six and four of six exercise variables with the V-slope method and the VentEq method, respectively. The V-slope and the VentEq method differed significantly on one of six exercise variables. Ten of thirteen ICCs that were >0.80 had a 95% CI > 0.70. The RER = 1 method and the V-slope method had the highest number of significant ICCs and 95% CIs. The V-slope method, the ventilatory equivalent method and the PET-O2 method are comparable and reliable methods to determine the VAT during CPET in children with CF or asoTGA.