Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations

Abstract

BP : blood pressure CHD : coronary heart disease CO2 : carbon dioxide COPD : chronic obstructive pulmonary disease CPX : cardiopulmonary exercise testing CRF : cardiorespiratory fitness CV : cardiovascular ECG : electrocardiogram EIB : exercise-induced bronchospasm EOV : exercise oscillatory ventilation ET : exercise testing FEV1 : forced expiratory volume in 1 s HCM : hypertrophic cardiomyopathy HF : heart failure HF-PEF : heart failure-preserved ejection fraction HR : heart rate HRR : heart rate recovery ILD : interstitial lung disease LVH : left ventricular hypertrophy MVV : maximal voluntary ventilation O2 : oxygen PAH : pulmonary arterial hypertension PEF : peak expiratory flow PETCO2 : partial pressure of end-tidal carbon dioxide PH : pulmonary hypertension Q : cardiac output RER : respiratory exchange ratio SpO2 : pulse oximetry US : United States VE : minute ventilation ![Graphic][1] : carbon dioxide production ![Graphic][2] : oxygen consumption VT : ventilatory threshold From an evidence-based perspective, cardiopulmonary exercise testing (CPX) is a well-supported assessment technique in both the United States (US) and Europe. The combination of standard exercise testing (ET) [i.e. progressive exercise provocation in association with serial electrocardiograms (ECGs), haemodynamics, oxygen saturation, and subjective symptoms] and measurement of ventilatory gas exchange amounts to a superior method to: (i) accurately quantify cardiorespiratory fitness (CRF), (ii) delineate the physiologic system(s) underlying exercise responses, which can be applied as a means to identify the exercise-limiting pathophysiological mechanism(s) and/or performance differences, and (iii) formulate function-based prognostic stratification. Cardiopulmonary ET certainly carries an additional cost as well as competency requirements and is not an essential component of evaluation in all patient populations. However, there are several conditions of confirmed, suspected, or unknown aetiology where the data gained from this form of ET is highly valuable in terms of clinical decision making.1 Several CPX statements have been published by well-respected organizations in both the US and Europe.1–5 Despite these prominent reports and the plethora of pertinent medical literature which they feature, underutilization of CPX persists. This discrepancy is at least partly attributable to the fact that the currently available CPX consensus statements are inherently complex and fail to convey succinct, clinically centred strategies to utilize CPX indices effectively. Likewise, current CPX software packages generate an overwhelming abundance of data, which to most clinicians are incomprehensible and abstract. Ironically, in contrast to the protracted scientific statements and dense CPX data outputs, the list of CPX variables that have proven clinical application is concise and uncomplicated. Therefore, the goal of this writing group is to present an approach of CPX in a way that assists in making meaningful decisions regarding a patient's care. Experts from the European Association of Cardiovascular Prevention and Rehabilitation and American … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif