Treadmill transforming into vascular system, symbolizing CPET and vascular health.

CPET for AAA Patients: Is It a Reliable Way to Assess Risk?

Theo Raines in Health & Wellness December 2025 • 4 min read.

"A new study confirms that cardiopulmonary exercise testing (CPET) can be a reliable tool for assessing risk in patients with abdominal aortic aneurysms (AAA), offering reassurance for clinicians."

Abdominal aortic aneurysms (AAA) affect a significant portion of the aging male population, often necessitating surgical intervention when the aneurysm reaches a critical size. Assessing a patient's overall fitness and risk factors is paramount before such procedures.

Cardiopulmonary exercise testing (CPET) has emerged as a valuable tool in this assessment process, providing insights into a patient's cardiovascular and respiratory health. CPET measures key indicators such as peak oxygen uptake (VO2peak) and ventilatory anaerobic threshold (VAT), which help predict postoperative outcomes.

However, the reliability of CPET measurements has been a topic of interest. A recent study published in the Annals of Vascular Surgery has shed light on the consistency and reliability of CPET results in patients with AAA, offering reassurance to clinicians who use this tool in their practice.

What the Study Revealed About CPET Reliability

Treadmill transforming into vascular system, symbolizing CPET and vascular health.

The study, conducted at a university teaching hospital, involved a randomized trial with patients undergoing CPET on either a cycle ergometer or a motorized treadmill. Researchers analyzed various CPET measures to determine their intra-rater (consistency within the same observer) and inter-rater (consistency between different observers) reliability.

The results indicated excellent intra-rater reliability for VAT on both the treadmill (r=0.834) and cycle ergometer (r=0.959). Inter-rater reliability also demonstrated high agreement, with values of r=0.983 for the treadmill and r=0.905 for the cycle. These findings suggest that CPET measurements are consistent and reproducible, regardless of who is administering or interpreting the test.

Here's a breakdown of the key findings:

Intra-rater Reliability: Excellent for VAT on both treadmill and cycle ergometer.
Inter-rater Reliability: High agreement between different observers.
Variable Consistency: Most CPET variables showed high intra-rater reliability.
VAT Stability: Ventilatory anaerobic threshold (VAT) demonstrated high consistency, which is vital because this measure often guides treatment decisions.

While most CPET variables demonstrated high reliability, there were some exceptions. The VE/VO2 on the treadmill showed substantial agreement rather than high agreement, and VO2PEAK on the cycle ergometer had only fair agreement. These exceptions highlight the importance of considering the specific measures and modalities when interpreting CPET results.

Implications for Clinical Practice

The findings of this study offer reassurance to clinicians who rely on CPET for risk assessment in patients with AAA. The high reliability of VAT, in particular, suggests that this measure can be confidently used to guide treatment decisions. However, clinicians should be mindful of the potential variability in other CPET measures and consider these factors when interpreting results.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1016/j.avsg.2018.08.087, Alternate LINK

Title: The Intrarater And Interrater Reliability Of Measures Derived From Cardiopulmonary Exercise Testing In Patients With Abdominal Aortic Aneurysms

Subject: Cardiology and Cardiovascular Medicine

Journal: Annals of Vascular Surgery

Publisher: Elsevier BV

Authors: Amy Elizabeth Harwood, Sean Pymer, Louise Hitchman, Joshua Totty, Tom Wallace, George E. Smith, Daniel Carradice, Sean Carroll, Ian C. Chetter

Published: 2019-04-01

Everything You Need To Know

What is cardiopulmonary exercise testing (CPET), and why is it used for patients with abdominal aortic aneurysms (AAA)?

Cardiopulmonary exercise testing (CPET) is a valuable assessment tool used to evaluate cardiovascular and respiratory health, particularly in patients with abdominal aortic aneurysms (AAA). It measures key indicators like peak oxygen uptake (VO2peak) and ventilatory anaerobic threshold (VAT) to predict postoperative outcomes. CPET helps clinicians understand a patient's fitness level and risk factors before surgical interventions, offering insights into their ability to withstand the stress of surgery.

Why is ventilatory anaerobic threshold (VAT) considered a critical measurement in cardiopulmonary exercise testing (CPET)?

Ventilatory anaerobic threshold (VAT) is crucial because it indicates the point during exercise at which anaerobic metabolism begins to supplement aerobic metabolism. VAT is a key measure of a patient's exercise capacity and cardiovascular fitness. Its reliability in CPET measurements means clinicians can confidently use it to guide treatment decisions for patients with AAA. The stability of VAT ensures that treatment strategies based on this measure are well-founded and consistent.

What do intra-rater and inter-rater reliability mean in the context of cardiopulmonary exercise testing (CPET), and why are they important?

Intra-rater reliability refers to the consistency of measurements taken by the same observer, while inter-rater reliability refers to the consistency of measurements taken by different observers. High intra-rater and inter-rater reliability in CPET measurements, particularly for VAT, suggests that the results are consistent and reproducible regardless of who is administering or interpreting the test. This consistency is essential for ensuring that treatment decisions are based on accurate and reliable data.

Are all measurements taken during cardiopulmonary exercise testing (CPET) equally reliable?

While many CPET variables show high reliability, some, like VE/VO2 on the treadmill and VO2PEAK on the cycle ergometer, may exhibit variability. VE/VO2 reflects ventilatory efficiency, while VO2PEAK indicates the maximum oxygen uptake during exercise. Clinicians should be aware of these potential inconsistencies and consider the specific measures and modalities when interpreting CPET results. A comprehensive approach that considers multiple factors will enhance the accuracy of risk assessment.

How does cardiopulmonary exercise testing (CPET) contribute to better risk assessment and outcomes for patients with abdominal aortic aneurysms (AAA)?

CPET enhances risk assessment in patients with AAA. By measuring key indicators like VO2peak and VAT, CPET provides a comprehensive evaluation of a patient's cardiovascular and respiratory health. This information allows clinicians to make informed decisions about the necessity and timing of surgical interventions, ultimately improving patient outcomes. The reliability of CPET ensures that these assessments are accurate and consistent, leading to more effective and personalized treatment plans.