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Total haemoglobin mass, but not haemoglobin concentration, is associated with preoperative cardiopulmonary exercise testing (CPET) derived oxygen consumption variables

Otto, JM; Plumb, JOM; Wakeham, D; Clissold, E; Loughney, L; Schmidt, W; Montgomery, H; ... Richards, T; + view all (2017) Total haemoglobin mass, but not haemoglobin concentration, is associated with preoperative cardiopulmonary exercise testing (CPET) derived oxygen consumption variables. British Journal of Anaesthesia , 118 (5) pp. 747-754. 10.1093/bja/aew445. Green open access

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Abstract

BACKGROUND: Cardiopulmonary exercise testing (CPET) measures peak exertional oxygen consumption ( V˙O2peakV˙O2peak ) and that at the anaerobic threshold ( V˙O2V˙O2 at AT, i.e. the point at which anaerobic metabolism contributes substantially to overall metabolism). Lower values are associated with excess postoperative morbidity and mortality. A reduced haemoglobin concentration ([Hb]) results from a reduction in total haemoglobin mass (tHb-mass) or an increase in plasma volume. Thus, tHb-mass might be a more useful measure of oxygen-carrying capacity and might correlate better with CPET-derived fitness measures in preoperative patients than does circulating [Hb]. METHODS: Before major elective surgery, CPET was performed, and both tHb-mass (optimized carbon monoxide rebreathing method) and circulating [Hb] were determined. RESULTS: In 42 patients (83% male), [Hb] was unrelated to V˙O2V˙O2 at AT and V˙O2peakV˙O2peak (r=0.02, P=0.89 and r=0.04, P=0.80, respectively) and explained none of the variance in either measure. In contrast, tHb-mass was related to both (r=0.661, P<0.0001 and r=0.483, P=0.001 for V˙O2V˙O2 at AT and V˙O2peakV˙O2peak , respectively). The tHb-mass explained 44% of variance in V˙O2V˙O2 at AT (P<0.0001) and 23% in V˙O2peakV˙O2peak (P=0.001). CONCLUSIONS: In contrast to [Hb], tHb-mass is an important determinant of physical fitness before major elective surgery. Further studies should determine whether low tHb-mass is predictive of poor outcome and whether targeted increases in tHb-mass might thus improve outcome.

Type: Article
Title: Total haemoglobin mass, but not haemoglobin concentration, is associated with preoperative cardiopulmonary exercise testing (CPET) derived oxygen consumption variables
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/bja/aew445
Publisher version: http://doi.org/10.1093/bja/aew445
Language: English
Additional information: VC The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Anaemia, anaerobic threshold, cardiopulmonary exercise test, oxygen consumption, physical fitness, surgery
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
URI: https://discovery.ucl.ac.uk/id/eprint/1529918
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