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Systole Quick Start Guide

PEDAL CPET Data Manager

Systole is a desktop application for cardiopulmonary exercise testing (CPET) data management. It predicts peak VO₂ using 8 validated normative equations, generates clinical reports with automated interpretation, creates individualized exercise prescriptions, and exports data to the PEDAL REDCap database. All data stays on your local machine — nothing is transmitted over the internet.

Downloading Systole

Systole is distributed as a desktop application for macOS and Windows. Download the latest build from the public releases page:

Download page: github.com/hansenje/systole-releases/releases

The newest version is always at the top of the page — download that one unless you were told otherwise. Anything labelled Pre-release is a test build; production sites should install the newest release without that label.

• macOS — download the .dmg, open it, and drag Systole into your Applications folder. The build is signed and notarized by Apple, so it opens without Gatekeeper warnings.
• Windows — download the .exe installer and run it.

Staying up to date: Systole checks for a newer release about once a day. When one is available, a green banner appears at the top of the app with a Download link that opens this same releases page — so once you're installed, you rarely need to find it by hand. To check on demand, use Settings → Software Updates → Check for Updates Now. Systole never downloads or installs an update on its own.

First-Time Setup

Try Demo Mode First

A fresh install of Systole opens in Demo mode with a bundled fictional database (7 patients, 12 tests, BxB and non-BxB samples). Use it to explore every feature without risk to real data. To switch to your real data, go to Settings → Application Mode and select Clinical. Systole restarts; the two databases stay completely separate and you can flip between them at any time.

Enter Your License Key

Systole is licensed per site. Your key comes from the coordinating center — paste it into Settings → License and click Verify & Apply. Until a valid key is entered, an amber banner appears at the top of the window; after a short grace period, creating tests, importing, and exporting are disabled (everything already in the database stays readable). The key is checked entirely on your machine — no internet connection is involved, then or ever.

Configure Site Settings

Before exporting any data to REDCap, configure these:

1. Site ID (Data Management tab → Site Configuration) — Enter the PEDAL Site ID assigned by the coordinating center (e.g., 6082) and click Save Site ID. This becomes the prefix for all REDCap record IDs.

2. Protocol Mappings (Data Management tab → Protocol Mappings) — Map your lab's protocol names (as they appear in Breeze exports) to the corresponding REDCap numeric codes. Click Scan Database to auto-detect protocol names from imported tests, then assign the correct code to each. Unmapped protocols are highlighted in red and will block REDCap export.

3. Default Normative References (Settings tab) — Choose which prediction equation to apply by default based on patient age group and exercise modality. For example, you might set Blanchard as the default for pediatric cycle ergometry and Wasserman for adult cycle. These defaults are applied automatically during bulk import and when no reference has been explicitly selected.

4. MedGraphics Connection (Settings tab, optional) — If your CPET system uses BreezeSuite MedGraphics on SQL Server, configure direct database access here. Once saved, MedGraphics import buttons appear on the Records tab and bulk import bar.

Typical Workflow

1. Import or Create a Test

From the Records tab:

• Import a Breeze file — Click Import, select one or more .sum files exported from your CPET system. Systole parses the file, creates a patient record (or matches to an existing patient by MRN), and populates all CPET fields automatically.

• Bulk import — Go to the Data Management tab, click Select Files or Select Folder, and choose .sum or .pedal files. Systole processes them sequentially, matching patients by MRN and flagging ambiguous matches or duplicate tests in the Review sub-tab for manual resolution.

• MedGraphics direct import (desktop app, after configuring the connection in Settings) — Click MedGraphics on the Records sub-tab bar to pick recent tests directly from the BreezeSuite database, or use the MedGraphics button next to Select Files / Select Folder for bulk import.

• Manual entry — Click + New Patient to create a patient, then + New Test to start a blank test. Enter demographics and CPET data on the Exercise tab.

2. Review and Edit CPET Data

Switch to the Exercise tab. The top summary bar shows patient demographics and key values. Below that, CPET data is organized in four columns: Rest, Anaerobic Threshold, Peak, and Recovery.

• Fields that can be calculated automatically (BMI, relative VO₂, O₂ pulse) update as you enter data.
• Exercise duration is entered as minutes and seconds.
• ECG findings are captured via structured radio buttons at the bottom of the page.

2a. Review Breath-by-Breath Data (if available)

If the test has breath-by-breath data, switch to the BxB tab (between Exercise and Reference) to see the Wasserman 9-Panel Plot and a time-down data table:

• View all 9 panels with selectable averaging methods (10s / 15s / 20s / 30s / 8-breath / Mid 5/7 / Raw)
• Drag the AT line on the V-slope panel to set or adjust the anaerobic threshold
• Click Adjust Exercise Window to drag exercise start/recovery markers
• Click Apply Changes to Test to commit averaging method, AT, and window changes to the test summary data
• Scroll down to see the time-down BxB data table with phase labels (Rest, AT, Peak) and exercise window markers

Note: The 9-panel plots and Exercise tab summary both use rolling averages computed from every breath (no resampling), so peak VO₂ and AT values will match. The time-down table resamples to fixed intervals (e.g., every 10 seconds for 30s averaging) for readability, so its displayed values are interpolated and may differ slightly from the Exercise tab summary.

3. Select a Normative Reference

Switch to the Reference tab to see predicted values from all 8 normative equations in a summary table. Each row shows:

• Status dot: green = appropriate, yellow = use with caution, red = not appropriate
• Predicted peak VO₂ (mL/min | mL/kg/min)
• Percent predicted and Z-score (if observed data entered)
• Equation note (which variant was selected)

Select the Report radio button on the equation that best fits your patient. Click any row to see the full detail panel with all predicted variables. Click the i button to view the equation formula and citation.

Choosing an equation: Click "Show Cross-Equation Comparison" in the detail panel to compare all datasets. In general:

• Pediatric cycle → Blanchard (provides Z-scores), Amedro, or Burstein
• Pediatric treadmill → Cooper or Fernie
• Adult cycle → Wasserman or Jones
• Adult treadmill → FRIEND or Wasserman

4. Generate the Clinical Report

Switch to the Report tab. Systole auto-generates a structured clinical impression based on the observed CPET values and the selected normative reference. The impression includes:

• Maximal test determination (based on RER, HR, and effort)
• Peak VO₂ interpretation with percent predicted or Z-score
• Anaerobic threshold assessment
• O₂ pulse interpretation
• Ventilatory efficiency (VE/VCO₂ slope)
• Heart rate response and chronotropic assessment

Below the impression, six narrative fields let you document:

• Blood pressure response (click Normal for standard text, or Generate to auto-fill from data)
• Oxygen saturation
• ECG findings
• Symptoms
• Comparison to prior tests
• Other comments

If more than one test exists for the patient, historical trend charts appear showing peak VO₂, AT, heart rate, and VE/VCO₂ slope over time.

5. Create an Exercise Prescription (if indicated)

Switch to the Prescription tab. Peak HR and resting HR are pulled automatically from the Exercise tab.

1. Select your risk stratification criteria: FORCE (9 domains, each rated FORCE 1 / 2 / 3) or Budts (12 categories, A–E grades).
2. Rate each physiologic domain (coronary anatomy, ventricular function, aortic dimensions, arrhythmia risk, etc.) — FORCE 1/2/3 for FORCE, or A–E for Budts.
3. Systole calculates the physiologic category and displays a target intensity table with heart rate zones, talk test guidance, and RPE ranges.
4. Select an exercise program phase (Beginner / Intermediate / Advanced).
5. Override any calculated targets if clinical judgment warrants it.
6. Enter the prescriber name, add any comments, and click Confirm Prescription.
7. Click Print to generate a patient-facing handout.

6. Verify

Mark the test as complete by clicking the Verify button in the demographics summary bar. This locks the test to prevent accidental edits and snapshots the currently selected normative reference into the test record. (Click Amend later if changes are needed.)

7. Export

Export to REDCap:

• Go to the Data Management tab and click Export REDCap CSV to open the export dialog.
• Build your selection with the quick-select buttons — Unexported (new tests since your last upload), All, None, or Current Test — then fine-tune by ticking individual rows. Only verified tests export by default; tick Include unverified tests and/or Include historical tests to widen the net.
• Click Download CSV — record IDs (SITE-PEDALID-VISIT) are generated automatically — and upload the file to your PEDAL REDCap project using its Data Import Tool.
• Back in Systole, reopen the dialog and click Confirm on the pending banner once the REDCap import succeeds, so future Unexported exports skip those records.

See Exporting to REDCap — Step by Step for the full walkthrough.

Key Concepts

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