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Exercise Oscillatory Ventilation: Inter-reviewer Agreement and a Novel Determination

Brawner Clinton A.; Ehrman, Jonathan K.; Myers, Jonathan; Chase, Paul; Vainshelboim, Baruch; Farha, Shadi; Saval, Matthew A.; McGuire, Rita; Pozehl, Bunny; Keteyian, Steven J.
Medicine & Science in Sports & Exercise: Post Acceptance: September 11, 2017
doi: 10.1249/MSS.0000000000001423
Special Communication: PDF Only

ABSTRACTIntroductionDetermination of exercise oscillatory ventilation (EOV) is subjective and the inter-reviewer agreement has not been reported. The purpose of this study was, among patients with heart failure (HF): (1) determine the inter-reviewer agreement for EOV; and (2) describe a novel, objective, and quantifiable measure of EOV.MethodsThis was a secondary analysis of the HEART Camp: Promoting Adherence to Exercise in Patients with Heart Failure study. EOV was determined through a blinded review by 6 individuals based on their interpretation of the EOV literature. Inter-reviewer agreement was assessed with Fleiss kappa (κ). Final determination of EOV was based on agreement by 4 of the 6 reviewers. A new measure (ventilation dispersion index; VDI) was calculated for each test and its ability to predict EOV was assessed with the receiver operator characteristics curve (ROC).ResultsAmong 243 patients with HF (age=60±12 years; 45% women) the inter-reviewer agreement for EOV was fair (κ=0.303) with 10-s discrete data averages and significantly better, but only moderate (κ= 0.429) with 30-s rolling data averages. Prevalence of positive and indeterminate EOVs were 18% and 30% with the 10-s discrete averages and 14% and 13% with the 30-s rolling averages, respectively. VDI was strongly associated with EOV with area under the ROC= 0.852 to 0.890.ConclusionsInter-reviewer agreement for EOV in patients with HF is fair to moderate which can negatively affect risk stratification. VDI has strong predictive validity with EOV; as such it might be a useful measure of prognosis in patients with HF.

Introduction

Determination of exercise oscillatory ventilation (EOV) is subjective and the inter-reviewer agreement has not been reported. The purpose of this study was, among patients with heart failure (HF): (1) determine the inter-reviewer agreement for EOV; and (2) describe a novel, objective, and quantifiable measure of EOV.

Methods

This was a secondary analysis of the HEART Camp: Promoting Adherence to Exercise in Patients with Heart Failure study. EOV was determined through a blinded review by 6 individuals based on their interpretation of the EOV literature. Inter-reviewer agreement was assessed with Fleiss kappa (κ). Final determination of EOV was based on agreement by 4 of the 6 reviewers. A new measure (ventilation dispersion index; VDI) was calculated for each test and its ability to predict EOV was assessed with the receiver operator characteristics curve (ROC).

Results

Among 243 patients with HF (age=60±12 years; 45% women) the inter-reviewer agreement for EOV was fair (κ=0.303) with 10-s discrete data averages and significantly better, but only moderate (κ= 0.429) with 30-s rolling data averages. Prevalence of positive and indeterminate EOVs were 18% and 30% with the 10-s discrete averages and 14% and 13% with the 30-s rolling averages, respectively. VDI was strongly associated with EOV with area under the ROC= 0.852 to 0.890.

Conclusions

Inter-reviewer agreement for EOV in patients with HF is fair to moderate which can negatively affect risk stratification. VDI has strong predictive validity with EOV; as such it might be a useful measure of prognosis in patients with HF.

Address for Correspondence: Clinton A. Brawner, PhD, Preventive Cardiology, Henry Ford Hospital, 6525 Second Ave., Detroit, Michigan, 48202, 313.972.4108 (voice); 313.972.1921 (fax), Cbrawne1@hfhs.org

These results do not constitute endorsement by ACSM. The HEART Camp study (clinicaltrials.gov NCT01658670) was supported by a grant from the National, Heart, Blood, and Lung Institute of the National Institutes of Health (award R01HL112979). This agency did not participate in the design, conduct, or analysis of the HEART Camp study. No external financial support was received for the present analysis. Drs. Brawner, Keteyian, and Ehrman operate an exercise testing data core laboratory for multi-site clinical trials. These services are provided based on a fee-for-service agreement between the sponsor and Henry Ford Health System. These include active service agreements with Actelion, Alnylam, and Heart Metabolics. The authors have no other conflicts or financial disclosures.

Accepted for Publication: 29 August 2017

© 2017 American College of Sports Medicine