Design and validation of an interpretative strategy for cardiopulmonary exercise tests

Background and objective: Cardiopulmonary exercise testing (CPET) is a common investigation for the evaluation of exertional dyspnoea. At present, there is no consensus on the best interpretative strategy and none of the available algorithms have been validated. The aim of this study was to develop and validate a standardized strategy for the interpretation of CPET. Methods: This study analysed 199 CPETs from patients with exertional dyspnoea. Using a set of 100 CPETs a standardized interpretation using a four‐step approach was developed that scored: examination quality, performance, exercise limitation and cofactors. A second set of 99 CPETs was interpreted by two experts in the field, initially independently and then in a consensus conference. The standardized interpretation was compared with each expert, the expert's consensus and the original clinical reports. Results: Matching between the standardized interpretation strategy and the expert consensus was 82%, 82% with one expert and 86% with a second expert and 64% with the original clinical reports. From one to four exercise‐relevant cofactors were found in 77% of the patients. Conclusion: The standardized interpretation showed a precision comparable to the opinion of a single expert and significantly improved the consistency in CPET reports in a pulmonary centre with different physicians and varying degrees of expertise.