CPET a useful cardiovascular risk assessment tool for patients undergoing cancer surgery

For patients undergoing surgery for oesophageal and gastric cancer, cardiopulmonary exercise testing (CPET) appears to be a reliable predictor of major cardiovascular complications, as reported in a study.

The study included 200 consecutive patients (mean age 68 years, 27.5 percent male) who underwent elective surgery for oesophageal and/or gastric cancer. All of them were subjected to symptom-limited CPET prior to their surgery to evaluate the potential of various test-derived parameters including anaerobic threshold (AT) with the goal of predicting cardiovascular complications within 30 days after surgery.

Of the patients, 54 had oesophageal surgery, 132 had gastric surgery, and 14 had combined oesophageal and gastric surgery. Cardiovascular complications occurred in 41 patients (20.5 percent) within 30 days after surgery, including four cases of nonfatal myocardial infarctions (2 percent) and one stroke episode (0.5 percent). Six patients died from cardiovascular causes (3 percent), and 30 experienced less serious complications (15 percent) such as angina attacks and antiarrhythmic therapy for ventricular arrhythmias or for atrial fibrillation/flutter.

Data from preoperative CPET indicated that an anaerobic threshold (AT) level <11 mL/kg/min was associated with more than sixfold greater likelihood of any cardiovascular complication following surgery (odds ratio [OR], 6.33, 95 percent confidence interval [CI], 1.78–22.47).

Of note, an AT level <9.5 showed the best predictive accuracy for major perioperative cardiac complications, with a sensitivity of 93 percent, specificity of 68 percent, positive predictive value of 75 percent, and negative predictive value of 98.8 percent.