{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:11:08Z","timestamp":1791612668799,"version":"4.3.4"},"reference-count":44,"publisher":"European Respiratory Society (ERS)","issue":"1","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"funder":[{"DOI":"10.13039\/100007454","name":"Shadyside Hospital Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007454","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2024,5,4]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The direct Fick principle is the standard for calculating cardiac output (CO) to detect CO-dependent conditions like exercise pulmonary hypertension (ePH). Fick CO<jats:sub>arterial<\/jats:sub>incorporates arterial haemoglobin (Hb<jats:sub>a<\/jats:sub>) and oxygen saturation (<jats:italic>S<\/jats:italic><jats:sub>aO<jats:sub>2<\/jats:sub><\/jats:sub>) with oxygen consumption from exercise testing, while Fick CO<jats:sub>non-arterial<\/jats:sub>substitutes mixed venous haemoglobin (Hb<jats:sub>mv<\/jats:sub>) and peripheral oxygen saturation (<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>) in the absence of an arterial line. The decision to employ an arterial catheter for exercise testing varies, and discrepancies in oxygen saturation and haemoglobin between arterial and non-arterial methods may lead to differences in Fick CO, potentially affecting ePH classification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective analysis of 296 consecutive invasive cardiopulmonary exercise testing (iCPET) studies comparing oxygen saturation from pulse oximetry (<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>) and radial arterial (<jats:italic>S<\/jats:italic><jats:sub>aO<jats:sub>2<\/jats:sub><\/jats:sub>), Hb<jats:sub>a<\/jats:sub>and Hb<jats:sub>mv<\/jats:sub>, and CO calculated with arterial (CO<jats:sub>arterial<\/jats:sub>) and non-arterial (CO<jats:sub>non-arterial<\/jats:sub>) values. We assessed the risk of misclassification of pre- and post-capillary ePH and data loss due to inaccurate<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When considering all stages from rest to peak exercise, Hb<jats:sub>a<\/jats:sub>and Hb<jats:sub>mv<\/jats:sub>demonstrated high correlation, while<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>and<jats:italic>S<\/jats:italic><jats:sub>aO<jats:sub>2<\/jats:sub><\/jats:sub>as well as CO<jats:sub>arterial<\/jats:sub>and CO<jats:sub>non-arterial<\/jats:sub>demonstrated low correlation. Data loss was significantly higher across all stages of exercise for<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>(n=346\/1926 (18%)) compared to<jats:italic>S<\/jats:italic><jats:sub>aO<jats:sub>2<\/jats:sub><\/jats:sub>(n=17\/1923 (0.88%)). We found that pre- and post-capillary ePH were misclassified as CO<jats:sub>non-arterial<\/jats:sub>data (n=7\/41 (17.1%) and n=2\/23 (8.7%), respectively). Patients with scleroderma and\/or Raynaud's (n=11\/33 (33.3%)) and black patients (n=6\/19 (31.6%)) had more<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>data loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Reliance upon<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>during invasive exercise testing results in the misclassification of pre- and post-capillary ePH, and unmeasurable<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>for black, scleroderma and Raynaud's patients can preclude accurate exercise calculations, thus limiting the diagnostic and prognostic value of invasive exercise testing without an arterial line.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.02232-2023","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T15:10:15Z","timestamp":1716477015000},"page":"2302232","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Non-arterial line cardiac output calculation misclassifies exercise pulmonary hypertension and increases risk of data loss particularly in black, scleroderma and Raynaud's patients during invasive exercise testing"],"prefix":"10.1183","volume":"64","author":[{"given":"Luiz","family":"Campedelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-0581","authenticated-orcid":false,"given":"S. Mehdi","family":"Nouraie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3334-7046","authenticated-orcid":false,"given":"Michael G.","family":"Risbano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"key":"2024102103270300000_64.1.2302232.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.104463"},{"key":"2024102103270300000_64.1.2302232.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701"},{"key":"2024102103270300000_64.1.2302232.3","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00021915"},{"key":"2024102103270300000_64.1.2302232.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.10.048"},{"key":"2024102103270300000_64.1.2302232.5","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00879-2022"},{"key":"2024102103270300000_64.1.2302232.6","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00578-2017"},{"key":"2024102103270300000_64.1.2302232.7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000667"},{"key":"2024102103270300000_64.1.2302232.8","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01913-2018"},{"key":"2024102103270300000_64.1.2302232.9","doi-asserted-by":"crossref","first-page":"655.e651","DOI":"10.1016\/j.jhsa.2019.11.007","article-title":"Acute upper-limb complications following radial artery catheterization for coronary angiography","volume":"45","author":"Harvey","year":"2020","journal-title":"J Hand Surg Am"},{"key":"2024102103270300000_64.1.2302232.10","unstructured":"US Food and Drug Administration . 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