{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:40:40Z","timestamp":1787611240550,"version":"build-2736575974"},"reference-count":32,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2026,1,20]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Determining whether a value falls within the expected range is a central step in cardiopulmonary exercise testing (CPET) interpretation. Conventional thresholds based on absolute or percentage-predicted values are widely used but fail to capture population variability. This study evaluated the validity of percentile-based thresholds derived from the Study of Health in Pomerania (SHIP) for a Western population and compared their impact on classification with conventional thresholds in individuals without known cardiorespiratory disease and patients with cardiorespiratory disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analysed 886 maximal CPETs from 294 individuals without known cardiorespiratory disease (control group) and 592 patients with COPD, interstitial lung disease, heart failure or pulmonary hypertension. Percentile-based thresholds were evaluated for suitability by comparing abnormality rates with the expected 5% in the control group for peak oxygen uptake (\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>\n                        O\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      <jats:sub>peak<\/jats:sub>\n                      ), ventilatory equivalent for carbon dioxide (\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>E<\/jats:sub>\n                      \/\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>\n                        CO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      nadir values), peak heart rate (HR\n                      <jats:sub>peak<\/jats:sub>\n                      ),\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>\n                        O\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/work rate (WR) slope and peak\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>\n                        O\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/HR. Agreement, discordance, and cumulative impact of percentile-based\n                      <jats:italic>versus<\/jats:italic>\n                      conventional thresholds were assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Percentile-based thresholds classified 4\u20138% of CPETs as abnormal in the control group, consistent with the expected 5%. In patients, conventional thresholds classified up to 14% more\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>\n                        O\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      <jats:sub>peak<\/jats:sub>\n                      values and 31% more HR\n                      <jats:sub>peak<\/jats:sub>\n                      values as abnormal compared with percentile-based thresholds, whereas percentile-based thresholds identified more abnormal\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>E<\/jats:sub>\n                      \/\n                      <jats:italic>V<\/jats:italic>\n                      \u2032\n                      <jats:sub>\n                        CO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      nadir values. Full agreement across all variables was observed in 82% of CPETs in the control group\n                      <jats:italic>versus<\/jats:italic>\n                      46\u201358% in patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The SHIP-derived percentile-based thresholds are valid for Western populations, and their application leads to substantial differences in abnormality classification of CPET results compared to conventional thresholds, especially in patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/23120541.01354-2025","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:15:19Z","timestamp":1773933319000},"page":"01354-2025","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Percentile-based\n                    <i>versus<\/i>\n                    conventional thresholds in cardiopulmonary exercise testing: a retrospective cross-sectional study"],"prefix":"10.1183","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4560-9078","authenticated-orcid":false,"given":"Micha\u00ebl","family":"Staes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6031-8171","authenticated-orcid":false,"given":"Marieke","family":"Wuyts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"De Vos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Troosters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1830-2982","authenticated-orcid":false,"given":"Wim","family":"Janssens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"2026082403351679000_12.4.01354-2025.1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12931-021-01895-6","article-title":"Practical guide to cardiopulmonary exercise testing in adults","volume":"23","author":"Glaab","year":"2022","journal-title":"Respir Res"},{"key":"2026082403351679000_12.4.01354-2025.2","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0186-2020"},{"key":"2026082403351679000_12.4.01354-2025.3","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.167.2.211"},{"key":"2026082403351679000_12.4.01354-2025.4","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0010-2024"},{"key":"2026082403351679000_12.4.01354-2025.5","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4103\/1817-1737.151438","article-title":"Cardiopulmonary exercise testing in the assessment of exertional dyspnea","volume":"10","author":"Datta","year":"2015","journal-title":"Ann Thorac Med"},{"key":"2026082403351679000_12.4.01354-2025.6","unstructured":"Shreffler J , Huecker MR . 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