PMID- 26969643 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20220317 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 6 IP - 3 DP - 2016 Mar 11 TI - Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery. PG - e010359 LID - 10.1136/bmjopen-2015-010359 [doi] LID - e010359 AB - INTRODUCTION: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia. METHODS AND ANALYSIS: The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro-BNP concentration. ETHICS AND DISSEMINATION: The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1-year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ FAU - Wijeysundera, Duminda N AU - Wijeysundera DN AUID- ORCID: 0000-0002-5897-8605 AD - St. Michael's Hospital/Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada. FAU - Pearse, Rupert M AU - Pearse RM AD - Queen Mary University of London, London, UK. FAU - Shulman, Mark A AU - Shulman MA AD - Alfred Hospital/Monash University, Melbourne, Victoria, Australia. FAU - Abbott, Tom E F AU - Abbott TE AD - Queen Mary University of London, London, UK. FAU - Torres, Elizabeth AU - Torres E AD - St. Michael's Hospital, Toronto, Ontario, Canada. FAU - Croal, Bernard L AU - Croal BL AD - NHS Grampian, Aberdeen, UK. FAU - Granton, John T AU - Granton JT AD - University Health Network/Mount Sinai Hospital/University of Toronto, Toronto, Ontario, Canada. FAU - Thorpe, Kevin E AU - Thorpe KE AD - University of Toronto/St. Michael's Hospital, Toronto, Ontario, Canada. FAU - Grocott, Michael P W AU - Grocott MP AD - University Hospital Southampton/University of Southampton, Southampton, UK. FAU - Farrington, Catherine AU - Farrington C AD - Alfred Hospital/Monash University, Melbourne, Victoria, Australia. FAU - Myles, Paul S AU - Myles PS AD - Alfred Hospital/Monash University, Melbourne, Victoria, Australia. FAU - Cuthbertson, Brian H AU - Cuthbertson BH AD - Sunnybrook Health Sciences Centre/University of Toronto, Toronto, Ontario, Canada. CN - METS Study Investigators LA - eng GR - MR/M017974/1/MRC_/Medical Research Council/United Kingdom GR - RP_2014-04-022/DH_/Department of Health/United Kingdom GR - 258245/CAPMC/CIHR/Canada PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20160311 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 RN - 0 (Biomarkers) RN - 0 (Peptide Fragments) RN - 0 (pro-brain natriuretic peptide (1-76)) RN - 114471-18-0 (Natriuretic Peptide, Brain) SB - IM EIN - BMJ Open. 2016;6(4):e010359corr1. PMID: 27118283 MH - Aged MH - Aged, 80 and over MH - Australia MH - Biomarkers/blood MH - Canada MH - Elective Surgical Procedures/*mortality MH - *Exercise Test MH - *Exercise Tolerance MH - Female MH - Follow-Up Studies MH - Humans MH - Logistic Models MH - Male MH - Myocardial Infarction/*epidemiology MH - Natriuretic Peptide, Brain/*blood MH - New Zealand MH - Peptide Fragments/*blood MH - Postoperative Period MH - Preoperative Period MH - Prognosis MH - Prospective Studies MH - ROC Curve MH - *Research Design MH - Risk Factors MH - United Kingdom PMC - PMC4800144 OTO - NOTNLM OT - Cardiopulmonary exercise testing OT - Natriuretic peptides OT - Postoperative complications OT - Preoperative assessment OT - Risk prediction FIR - Wallace, S IR - Wallace S FIR - Thompson, B IR - Thompson B FIR - Ellis, M IR - Ellis M FIR - Borg, B IR - Borg B FIR - Kerridge, R IR - Kerridge R FIR - Douglas, J IR - Douglas J FIR - Brannan, J IR - Brannan J FIR - Pretto, J IR - Pretto J FIR - Godsall, M G IR - Godsall MG FIR - Beauchamp, N IR - Beauchamp N FIR - Allen, S IR - Allen S FIR - Kennedy, A IR - Kennedy A FIR - Wright, E IR - Wright E FIR - Malherbe, J IR - Malherbe J FIR - Ismail, H IR - Ismail H FIR - Riedel, B IR - Riedel B FIR - Melville, A IR - Melville A FIR - Sivakumar, H IR - Sivakumar H FIR - Murmane, A IR - Murmane A FIR - Kenchington, K IR - Kenchington K FIR - Gurunathan, U IR - Gurunathan U FIR - Stonell, C IR - Stonell C FIR - Brunello, K IR - Brunello K FIR - Steele, K IR - Steele K FIR - Tronstand, O IR - Tronstand O FIR - Masel, P IR - Masel P FIR - Dent, A IR - Dent A FIR - Smith, E IR - Smith E FIR - Bodger, A IR - Bodger A FIR - Abolfathi, M IR - Abolfathi M FIR - Sivalingam, P IR - Sivalingam P FIR - Hall, A IR - Hall A FIR - Painter, T IR - Painter T FIR - Elliott, A IR - Elliott A FIR - Carrera, A M IR - Carrera AM FIR - Terblanche, N C S IR - Terblanche NC FIR - Pitt, S IR - Pitt S FIR - Samuels, J IR - Samuels J FIR - Wilde, C IR - Wilde C FIR - MacCormick, M IR - MacCormick M FIR - Leslie, K IR - Leslie K FIR - Bramley, D IR - Bramley D FIR - Southcott, A M IR - Southcott AM FIR - Grant, J IR - Grant J FIR - Taylor, H IR - Taylor H FIR - Bates, S IR - Bates S FIR - Towns, M IR - Towns M FIR - Tippett, A IR - Tippett A FIR - Marshall, F IR - Marshall F FIR - Mazer, C D IR - Mazer CD FIR - Kunasingam, J IR - Kunasingam J FIR - Yagnik, A IR - Yagnik A FIR - Crescini, C IR - Crescini C FIR - McCartney, C J L IR - McCartney CJ FIR - Choi, S IR - Choi S FIR - Somascanthan, P IR - Somascanthan P FIR - Flores, K IR - Flores K FIR - Beattie, W S IR - Beattie WS FIR - Karkouti, K IR - Karkouti K FIR - Clarke, H A IR - Clarke HA FIR - Jerath, A IR - Jerath A FIR - McCluskey, S A IR - McCluskey SA FIR - Wasowicz, M IR - Wasowicz M FIR - Day, L IR - Day L FIR - Pazmino-Canizares, J IR - Pazmino-Canizares J FIR - Oh, P IR - Oh P FIR - Belliard, R IR - Belliard R FIR - Lee, L IR - Lee L FIR - Dobson, K IR - Dobson K FIR - Chan, V IR - Chan V FIR - Brull, R IR - Brull R FIR - Ami, N IR - Ami N FIR - Stanbrook, M IR - Stanbrook M FIR - Kagen, K IR - Kagen K FIR - Campbell, D IR - Campbell D FIR - Short, T IR - Short T FIR - Van Der Westhuizen, J IR - Van Der Westhuizen J FIR - Higgie, K IR - Higgie K FIR - Lindsay, H IR - Lindsay H FIR - Jang, R IR - Jang R FIR - Wong, C IR - Wong C FIR - Mcallister, D IR - Mcallister D FIR - Ali, M IR - Ali M FIR - Kumar, J IR - Kumar J FIR - Waymouth, E IR - Waymouth E FIR - Dimech, J IR - Dimech J FIR - Lorimer, M IR - Lorimer M FIR - Sara, R IR - Sara R FIR - Collingwood, A IR - Collingwood A FIR - Olliff, S IR - Olliff S FIR - Gabriel, S IR - Gabriel S FIR - Houston, H IR - Houston H FIR - Dalley, P IR - Dalley P FIR - Hurford, S IR - Hurford S FIR - Hunt, A IR - Hunt A FIR - Andrews, L IR - Andrews L FIR - Navarra, L IR - Navarra L FIR - Jason-Smith, A IR - Jason-Smith A FIR - Lum, M IR - Lum M FIR - Martin, D IR - Martin D FIR - James, S IR - James S FIR - Phull, M IR - Phull M FIR - Beilstein, C IR - Beilstein C FIR - Bodger, P IR - Bodger P FIR - Everingham, K IR - Everingham K FIR - Hu, Y IR - Hu Y FIR - Niebrzegowska, E IR - Niebrzegowska E FIR - Corriea, C IR - Corriea C FIR - Creary, T IR - Creary T FIR - Januszekska, M IR - Januszekska M FIR - Ahmad, T IR - Ahmad T FIR - Whalley, J IR - Whalley J FIR - Haslop, R IR - Haslop R FIR - McNeil, J IR - McNeil J FIR - Brown, A IR - Brown A FIR - MacDonald, N IR - MacDonald N FIR - Jhani, S IR - Jhani S FIR - Raobaikady, R IR - Raobaikady R FIR - Black, E IR - Black E FIR - Rooms, M IR - Rooms M FIR - Lawrence, H IR - Lawrence H FIR - Jack, S IR - Jack S FIR - Celinski, M IR - Celinski M FIR - Levett, D IR - Levett D FIR - Edwards, M IR - Edwards M FIR - Salmon, K IR - Salmon K FIR - Bolger, C IR - Bolger C FIR - Loughney, L IR - Loughney L FIR - Seaward, L IR - Seaward L FIR - Collins, H IR - Collins H FIR - Tyrell, B IR - Tyrell B FIR - Tantony, N IR - Tantony N FIR - Golder, K IR - Golder K FIR - Ackland, G IR - Ackland G FIR - Stephens, R C M IR - Stephens RC FIR - Gagello-Paredes, L IR - Gagello-Paredes L FIR - Raj, A IR - Raj A FIR - Lifford, R IR - Lifford R FIR - Melo, M IR - Melo M FIR - Mamdani, M IR - Mamdani M FIR - Hillis, G IR - Hillis G FIR - Wijeysundera, H C IR - Wijeysundera HC EDAT- 2016/03/13 06:00 MHDA- 2016/12/15 06:00 PMCR- 2016/03/11 CRDT- 2016/03/13 06:00 PHST- 2016/03/13 06:00 [entrez] PHST- 2016/03/13 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] PHST- 2016/03/11 00:00 [pmc-release] AID - bmjopen-2015-010359 [pii] AID - 10.1136/bmjopen-2015-010359 [doi] PST - epublish SO - BMJ Open. 2016 Mar 11;6(3):e010359. doi: 10.1136/bmjopen-2015-010359.