Peculiarities of interpretation of ergospirometry results in patients of older age groups

Ergospirometry is used to assess the perioperative prognosis in patients of different age groups, and traditionally, the indicators recorded on the peak of the exercise are evaluated. Achieving peak values during the study may be difficult for people over 60 years old with comorbid pathology, and therefore it is important to study the dynamics of the subthreshold values recorded during stress testing and the dynamics of their changes. A retrospective analysis of clinical and anamnestic data and ergospirometry parameters was performed in 100 patients (mean age (68,0 ± 2.6) year) who underwent planned lobectomy for stage II lung cancer. The following ergospirometry indicators were prognostically significant in relation to the risk of perioperative complications: the level of oxygen consumption and energy consumption at all stages of ergospirometry, starting from the adaptation stage; the dynamics of a decrease in cardiac output in the first minutes of exercise; the level of the anaerobic threshold; index of respiratory reserve at all stages of the study.

BACKGROUND. The ergospirometry technique is used to assess exercise tolerance, differential diagnosis of shortness of breath, detection of previously unverified pathology of the cardiovascular and respiratory systems, assessment of the patient's preoperative status and rehabilitation measures. The presence of frailty and associated geriatric syndromes is considered an unfavorable prognostic factor, but the degree of their influence requires clarification. At the same time, it is necessary to take into account that adaptive reserves and, as a result, the ability to maintain homeostasis under the influence of a stressful factor are individual. In this regard, along with the presence of frailty syndrome, age-related viability must be taken into account. The value of ergospirometry for older people lies in the simultaneous assessment of a large number of parameters of the cardiorespiratory link and the metabolic profile under standardized load conditions. To determine the perioperative prognosis, parameters such as the level of oxygen consumption at the peak of exercise and at the anaerobic threshold, and the ventilation carbon dioxide equivalent are traditionally evaluated. Achieving peak values during the study may be difficult for people over 60 years old with comorbid pathology, and therefore it is important to study the dynamics of the subthreshold values recorded during stress testing and the dynamics of their changes.

OBJECTIVE. Identification of the features of physiological reactions during cardiorespiratory stress in elderly people.

MATERIALS AND METHODS. A retrospective analysis of clinical and anamnestic data and ergospirometry indicators of patients examined at the oncological department No. 4 (thoracic department) of St. Petersburg A.P. Pavlov First State Medical University was carried out. The criteria for inclusion in the study were: elderly age, the availability of comprehensive geriatric assessment data, the possibility of performing ergospirometry on a bicycle ergometer according to a standardized ramp exercise protocol, the absence of absolute contraindications to performing exercise testing, and the availability of voluntary informed consent to conduct the study. A total of 100 people were included in the study, the average age was (68.0 ± 2.6) year (84 men, 16 women). All patients were admitted to the department as planned due to the presence of stage II lung cancer in order to perform a planned lobectomy operation. An assessment of the presence of chronic somatic pathology, a comprehensive geriatric assessment, preoperative ergospirometry, and an analysis of the features of the perioperative period were performed.

RESULTS. Frailty syndrome was detected in 39 % of patients, and prefrailty was observed in 29 % of the subjects. All patients had hypertension, 28% had ischemic heart disease, and 64 % had COPD. Patients with frailty syndrome showed lower values characterizing the level of oxygen consumption (p = 0.02) and energy consumption (p = 0.05) at all stages of ergospirometry, starting from the stage of adaptation (pedaling without load) compared with patients without frailty. In patients with frailty and prefrailty, there was a decrease in cardiac output by 15–25 % at the initial stage of the study (in the first minutes of exercise), more pronounced in the presence of frailty, which did not correlate with clinical and anamnestic data on the presence of coronary artery disease or clinically significant chronic heart failure. There was also an earlier achievement of the anaerobic threshold in patients with frailty syndrome with patients with prefrailty (p = 0.02) and patients without these geriatric syndromes (p = 0.0006). The load level to achieve the anaerobic threshold was (42.5 ± 4.6) W, (56.2 ± 3.4) W and (62.3 ± 2.9) W, respectively.

Nonfatal complications associated with surgery were reported in 14 % of patients, and no deaths were observed. The analysis of ergospirometry results revealed a statistically significant increase in the level of the respiratory reserve index at each stage of the study in all patients with perioperative complications (sensitivity of this parameter was 66.7–91.7 %, specificity was 64.2–88.0 %, depending on the stage of exercise).

CONCLUSION. The indicators recorded at the initial stages of ergospirometry may have significant prognostic value for assessing the adaptive potential of the body of elderly patients.