Cardiopulmonary Exercise Testing In Adults Research Articles

Short-term results of serial cardiopulmonary exercise testing in adults with repaired coarctation of the aorta

Background Data on the evolution of exercise capacity in adults with repaired coarctation of the aorta (CoA) are scarce. We aimed to investigate the evolution and change of measures of exercise capacity obtained by cardiopulmonary exercise testing (CPET) in adults with repaired CoA. Methods Patients 16 years of age and older with CoA, who performed at least two maximal CPETs in our institution, were included in the study. The first and last available tests were used for comparative statistical analysis of common exercise variables. Results Sixty patients (43 men) performed serial maximal CPET. Mean age at first assessment was 30 ± 10 years (range 17–68). Mean time between first and last assessment was 3.5 years (range 1–7). Mean peak VO2 was 85.6 ± 20.4% of the predicted value at the initial test, and 87.0 ± 20.5% at the final test (p = 0.294). There were no significant differences in the mean values of oxygen pulse, VO2 at anaerobic threshold, systolic and diastolic blood pressures and peak heart rate between the two assessments. There was a slightly higher VE/VCO2 slope at the final test (p = 0.047). Higher age and Borg scale were found to be related with a decline in percent-predicted peak VO2 from initial to final assessment. Conclusion In adults with repaired CoA, we found no significant change in peak VO2 during a mean follow-up of 3.5 years, yet a small increase in VE/VCO2 slope was observed. Higher age was predictive for a decline in percent-predicted peak VO2, starting in the third decade of life.

Cardiopulmonary exercise testing in adults with congenital heart disease: Prognostic role in cyanotic patients

IntroductionThere are few and conflicting data concerning cardiopulmonary exercise testing (CPET) in cyanotic congenital heart disease (CHD) in whom the ventilation patterns could be affected. Aim was to assess the functional capacity and stratifying power of CPET in cyanotic CHD. MethodsRetrospective evaluation of CHD adults submitted to CPET in a tertiary centre and followed for at least one year. Patients were divided according to presence of cyanosis (rest oxygen saturation<90%). CPET parameters were analysed as potential predictors of the primary endpoint of cardiac death and hospitalization. Results286 patients, median age 34 years and 3.6 years of follow-up, sixty (21%) cyanotic. Primary endpoint was reached by 49.1% and 22.9% in cyanotic and non-cyanotic patients, respectively. There were significant differences in CPET parameters: cyanotic patients had lowest values for peak oxygen consumption, partial pressure end-tidal carbon dioxide stages, chronotropic index and higher minute ventilation/carbon dioxide production slope and optimal point of ventilation. In cyanotic population the predictors of primary endpoint were: chronotropic index (HR 0.985) in non-Eisenmenger patients; optimal point of ventilation (HR 1.269), rest oxygen saturation (HR 0.621), partial pressure end-tidal carbon dioxide at anaerobic threshold (HR 0.952) and chronotropic index (HR 0.973) after Fontan circulation; partial pressure end-tidal carbon dioxide at rest (HR 1.129) and rest oxygen saturation (HR 1.129) after biventricular repair. ConclusionCyanotic patients had worst exercise capacity and prognosis. Non-traditional CPET parameters as chronotropic index, optimal point of ventilation and partial pressure end-tidal carbon dioxide stages can predict major cardiac events in cyanotic subgroups.

Differences in Physiological Responses to Cardiopulmonary Exercise Testing in Adults With and Without Type 1 Diabetes: A Pooled Analysis.

To investigate physiological responses to cardiopulmonary exercise (CPX) testing in adults with type 1 diabetes compared with age-, sex-, and BMI-matched control participants without type 1 diabetes. We compared results from CPX tests on a cycle ergometer in individuals with type 1 diabetes and control participants without type 1 diabetes. Parameters were peak and threshold variables of VO2, heart rate, and power output. Differences between groups were investigated through restricted maximum likelihood modeling and post hoc tests. Differences between groups were explained by stepwise linear regressions (P < 0.05). Among 303 individuals with type 1 diabetes (age 33 [interquartile range 22; 43] years, 93 females, BMI 23.6 [22; 26] kg/m2, HbA1c 6.9% [6.2; 7.7%] [52 (44; 61) mmol/mol]), VO2peak (32.55 [26.49; 38.72] vs. 42.67 ± 10.44 mL/kg/min), peak heart rate (179 [170; 187] vs. 184 [175; 191] beats/min), and peak power (216 [171; 253] vs. 245 [200; 300] W) were lower compared with 308 control participants without type 1 diabetes (all P < 0.001). Individuals with type 1 diabetes displayed an impaired degree and direction of the heart rate-to-performance curve compared with control participants without type 1 diabetes (0.07 [-0.75; 1.09] vs. 0.66 [-0.28; 1.45]; P < 0.001). None of the exercise physiological responses were associated with HbA1c in individuals with type 1 diabetes. Individuals with type 1 diabetes show altered responses to CPX testing, which cannot be explained by HbA1c. Intriguingly, the participants in our cohort were people with recent-onset type 1 diabetes; heart rate dynamics were altered during CPX testing.

Maximal versus sub-maximal effort during cardiopulmonary exercise testing in adults with congenital heart disease: outcome analysis of short-term cardiac-related events.

Peak respiratory exchange ratio is an objective marker of patient effort during cardiopulmonary exercise testing. We evaluated exercise variables in 175 adult congenital heart disease patients and the impact of respiratory exchange ratio on the prognostic value of exercise variables for short-term cardiac-related events. Of 175 patients, 110 completed the exercise test with a peak respiratory exchange ratio of ≥1.10 and the remaining 65 had a peak respiratory exchange ratio of <1.10. Peak oxygen consumption, the percentage of oxygen consumption at the ventilatory threshold, peak heart rate, percentage predicted peak heart rate, double product, oxygen uptake efficiency slope, and the number of patients with exercise oscillatory ventilation were reduced significantly in patients with a respiratory exchange ratio of <1.10 compared to those with a respiratory exchange ratio of ≥1.10. After a median follow-up of 21 months, total cardiac-related events occurred in 37 (21%) patients. Multivariate Cox proportional hazard analysis showed that the percentage predicted peak oxygen consumption, and oxygen uptake efficiency slope were independent predictors of cardiac-related events only in patients with a peak respiratory exchange ratio of ≥1.10. Sub-maximal exercise performance can be preserved in adult congenital heart disease patients. The percentage predicted oxygen consumption and the oxygen uptake efficiency slope are two independent predictors for short-term cardiac-related events in adult congenital heart disease patients.

Poor Cardiac Function is Associated With Renal Injury Following EVAR

Poor Cardiac Function is Associated With Renal Injury Following EVAR

343 - Cardiopulmonary Exercise Testing in Adults with Congential Heart Disease Underestimates Diesease Deverity Prior to Cardiac Transplantation

343 - Cardiopulmonary Exercise Testing in Adults with Congential Heart Disease Underestimates Diesease Deverity Prior to Cardiac Transplantation

Cardiopulmonary exercise testing in adults with congenital heart disease

Cardiopulmonary exercise testing is a valuable but underutilized tool in congenital cardiology. This diagnostic test allows for objective quantification of exercise limitation and enables the clinician to determine the source of the patient's exercise impairment. This article will discuss the abundance of information which can be garnished from the cardiopulmonary exercise stress test.

Cardiopulmonary Exercise Testing in Adults with Congenital Heart Disease

The primary task of the cardiopulmonary system is to provide blood flow and oxygen in quantities sufficient to support the individual's metabolic needs. The cardiopulmonary system is maximally stressed when an individual's metabolic rate is increased, a condition that occurs most commonly during physical activity or exercise. Cardiopulmonary exercise testing (CPX) quantitatively assesses a patient's capacity to adapt to the hemodynamic demands of exercise. Those who are found to have a cardiopulmonary system incapable of supporting normal amounts of exercise are likely to be less resilient, more vulnerable to illnesses, and more predisposed to health complications when confronting the inevitable challenges of life. A weakened cardiopulmonary system is also likely to be more susceptible to further damage or injury. It is therefore not surprising that data from CPX has been found to carry powerful and important prognostic implications. Article see p 250 Indeed, past studies have found that the peak oxygen consumption (Vo2) is one of the best predictors of morbidity or mortality in a variety of cardiovascular conditions including congestive heart failure,1,2 pulmonary hypertension,3 tetralogy of Fallot,4 transposition of the great arteries,5 and Fontan circulations.6 The article by Inuzuka et al7 is the latest contribution to this literature. These investigators have collected a large and diverse cohort of patients with congenital heart disease and have used novel, sophisticated statistical analyses to …

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

Exercise testing remains a remarkably durable and versatile tool that provides valuable diagnostic and prognostic information regarding patients with cardiovascular and pulmonary disease. Exercise testing has been available for more than a half century and, like many other cardiovascular procedures, has evolved in its technology and scope. When combined with exercise testing, adjunctive imaging modalities offer greater diagnostic accuracy, additional information regarding cardiac structure and function, and additional prognostic information. Similarly, the addition of ventilatory gas exchange measurements during exercise testing provides a wide array of unique and clinically useful incremental information that heretofore has been poorly understood and underutilized by the practicing clinician. The reasons for this are many and include the requirement for additional equipment (cardiopulmonary exercise testing [CPX] systems), personnel who are proficient in the administration and interpretation of these tests, limited or absence of training of cardiovascular specialists and limited training by pulmonary specialists in this technique, and the lack of understanding of the value of CPX by practicing clinicians. Modern CPX systems allow for the analysis of gas exchange at rest, during exercise, and during recovery and yield breath-by-breath measures of oxygen uptake (Vo2), carbon dioxide output (Vco2), and ventilation (Ve). These advanced computerized systems provide both simple and complex analyses of these data that are easy to retrieve and store, which makes CPX available for widespread use. These data can be readily integrated with standard variables measured during exercise testing, including heart rate, blood pressure, work rate, electrocardiography findings, and symptoms, to provide a comprehensive assessment of exercise tolerance and exercise responses. CPX can even be performed with adjunctive imaging modalities for additional diagnostic assessment. Hence, CPX offers the clinician the ability to obtain a wealth of information beyond standard exercise electrocardiography testing that when appropriately applied and interpreted …

Usefulness of Cardiopulmonary Exercise to Predict Long-Term Prognosis in Adults With Repaired Tetralogy of Fallot

Adults with tetralogy of Fallot (TOF) have increased long-term mortality. The identification of patients at greater risk for death or cardiac-related morbidity is challenging. This study was conducted to assess the prognostic value of cardiopulmonary exercise testing in adults with repaired TOF. One hundred eighteen consecutive adults with repaired TOF (mean age at repair 4.8 +/- 4.2 years) underwent cardiopulmonary exercise testing at a mean age of 24 +/- 8 years (range 16 to 59). The degree of pulmonary regurgitation, right ventricular function, and right ventricular systolic pressure were determined by transthoracic echocardiography. After the exercise tests, patients were regularly followed up for cardiac-related events. During a mean follow-up of 5.8 +/- 2.3 years (range 0.6 to 9.7), 9 patients died and 18 underwent hospitalization. Peak oxygen uptake (hazard ratio 0.974, 95% confidence interval 0.950 to 0.994), the slope of ventilation (VE) per unit of carbon dioxide production (VCO(2)) (hazard ratio 1.076, 95% confidence interval 1.038 to 1.115), and New York Heart Association functional class (hazard ratio 2.118, 95% confidence interval 1.344 to 3.542) were independent predictors of death or hospitalization. Patients with peak oxygen uptake < or =36% of predicted value and those with VE/VCO(2) slopes >39 were at greater risk for cardiac-related death (5-year mortality 48% vs 0%, p <0.0001, and 31% vs 0%, p <0.0001, respectively). In conclusion, the measurement of peak oxygen uptake and VE/VCO(2) slope in adults with repaired TOF can be prognostically important and could become a powerful tool to rationalize decisions regarding the prevention of premature sudden death and the need for reintervention.