ỨNG DỤNG NGHIỆM PHÁP GẮNG SỨC HÔ HẤP TIM MẠCH TRONG BỆNH LÝ TIM MẠCH
Nội dung chính của bài viết
Tóm tắt
Mặc dù có những tiến bộ trong công nghệ liên quan đến xét nghiệm chẩn đoán và sự phổ biến của các kỹ thuật hình ảnh, việc đánh giá khả năng gắng sức cung cấp sự cải tiến quan trọng trong việc đánh giá bệnh nhân mắc hoặc nghi ngờ mắc bệnh tim mạch hoặc bệnh phổi. Nghiệm pháp gắng sức hô hấp tim mạch (CPET) là phương pháp đánh giá tổng hợp và không xâm lấn về đáp ứng của hệ tim mạch, hô hấp và cơ xương trong khi gắng sức. CPET cung cấp các thông tin chi tiết về thăm dò chức năng tim mạch, nâng cao độ chính xác của chẩn đoán và khả năng dự đoán các biến cố tim mạch thông qua các thông số như VO2peak và độ dốc VE/VCO2. Bài viết phân tích giá trị của CPET trong chẩn đoán và quản lý bệnh lý tim mạch trong lâm sàng. Đồng thời, bài viết cũng cung cấp cho các bác sĩ lâm sàng về chỉ định, ứng dụng và cách phân tích cơ bản của CPET trong bệnh tim mạch.
Từ khóa
CPET, nghiệm pháp gắng sức hô hấp tim mạch, bệnh tim mạch
Chi tiết bài viết
Tài liệu tham khảo
1. Balady G.J, Arena R, Sietsema K, et al. Clinician's guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010.
122(2), 191–225, doi: 10.1161/CIR.0b013e3181e52e69.
2. Gibbons R.J, Balady G.J, Beasley J.W, et al. ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997. 30(1), 260– 311, doi: 10.1016/s0735-1097(97)00150-2.
3. Piepoli M.F, Corra U, Agostoni P.G, et al. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Eur J Cardiovasc Prev Rehabil. 2006. 13 (1), 300–311, doi: 10.1097/00149831-200602000-00003.
4. American Thoracic Society, American College of Chest Physicians. ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med. 2003. 167(2), 211–277, doi: 10.1164/rccm.167.2.211
5. Guazzi M, Adams V, Conraads V, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012. 126(18), 2261-74, doi: 10.1161/CIR.0b013e31826fb946.
6. Marcadet D.M, Pavy B, Bosser G, Claudot F, Corone S, et al. French Society of Cardiology guidelines on exercise tests (part 2): Indications for exercise tests in cardiac diseases. Arch Cardiovasc Dis. 2019. 112(1), 56-66, doi: 10.1016/j.acvd.2018.07.001.
7. Pritchard A, Burns P, Correia J, Jamieson P, et al. ARTP statement on cardiopulmonary exercise testing 2021. BMJ Open Respir Res. 2021. 8(1), e001121, doi: 10.1136/bmjresp-2021-001121.
8. William K, John B. A practical guide to the interpretation of cardiopulmonary exercise tests. Oxford University Press. 2014. 17-49.
9. Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation. 2011. 123(6), 668–680, doi: 10.1161/CIRCULATIONAHA.109.914788.
10. Poggio R, Arazi H.C, Giorgi M, Miriuka S.G. Prediction of severe cardiovascular events by VE/Vco2 slope versus peak Vo2 in systolic heart failure: A meta-analysis of the published literature. Am Heart J. 2010. 160(6), 1004–1014, doi: 10.1016/j.ahj.2010.08.037.
11. Arena R, Myers J, Abella J, et al. Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure. Circ Heart Fail. 2010. 3(3), 405–411, doi: 10.1161/CIRCHEARTFAILURE.109.906446.
12. Guazzi M, Arena R, Ascione A, Piepoli M, Guazzi M.D. Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value. Am Heart J. 2007. 153(5), 859–867, doi:
10.1016/j.ahj.2007.02.034.
13. Guazzi M, Myers J, Peberdy M.A, Bensimhon D, Chase P, Arena R. Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights. Eur Heart J. 2008. 29(22), 2751–2759, doi: 10.1093/eurheartj/ehn437.
14. Arena R, Lavie CJ, Milani R.V, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant. 2010. 29(2), 159–173, doi: 10.1016/j.healun.2009.09.003.
15. Arena R. Detecting abnormal pulmonary hemodynamics with cardiopulmonary exercise testing. Med Sci Sports Exerc. 2011. 43(6), 982, doi: 10.1249/MSS.0b013e31820e5fb3.
16. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the Factors Related to Mortality in Chronic Obstructive Pulmonary Disease: Role of Exercise Capacity and Health Status. Am J Respir Crit Care Med. 2003. 167(4), 544–549, doi: 10.1164/rccm.200206-583OC.
17. Gibbons R.J, Balady G.J, Timothy B.J, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise
Testing Guidelines). Circulation. 2002. 106(14), 1883–1892, doi:
10.1161/01.cir.0000034670.06526.15
18. Sharma S, Elliott P.M, Whyte G, et al. Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes. J Am Coll Cardiol. 2000. 36(3), 864–870, doi: 10.1016/s0735-1097(00)00816-0.
19. Sorajja P, Allison T, Hayes C, Nishimura R.A, Lam C.S.P, Ommen S.R. Prognostic Utility of Metabolic Exercise Testing in Minimally Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy. Am J Cardiol. 2012. 09(10), 1494-8. doi:
10.1016/j.amjcard.2012.01.363.
20. Pinkstaff S, Peberdy M.A, Fabiato A, Finucane S, Arena R. The clinical utility of cardiopulmonary exercise testing in suspected or confirmed myocardial ischemia. Am J Lifestyle Med. 2010. 4(4), 327–348, doi: 10.1177/1559827610362955.
21. Belardinelli R, Lacalaprice F, Carle F, et al. Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing. Eur Heart J. 2003. 24(14), 1304–1313, doi: 10.1016/s0195-668x(03)00210-0.
22. Cortina C, Sarrion C, Suberviola S, et al. Prognostic value of cardiopulmonary exercise testing in valvular heart disease, European Heart Journal, Volume 42, Issue Supplement_1, October 2021, ehab724.0126, doi: 10.1093/eurheartj/ehab724.0126.
122(2), 191–225, doi: 10.1161/CIR.0b013e3181e52e69.
2. Gibbons R.J, Balady G.J, Beasley J.W, et al. ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997. 30(1), 260– 311, doi: 10.1016/s0735-1097(97)00150-2.
3. Piepoli M.F, Corra U, Agostoni P.G, et al. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Eur J Cardiovasc Prev Rehabil. 2006. 13 (1), 300–311, doi: 10.1097/00149831-200602000-00003.
4. American Thoracic Society, American College of Chest Physicians. ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med. 2003. 167(2), 211–277, doi: 10.1164/rccm.167.2.211
5. Guazzi M, Adams V, Conraads V, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012. 126(18), 2261-74, doi: 10.1161/CIR.0b013e31826fb946.
6. Marcadet D.M, Pavy B, Bosser G, Claudot F, Corone S, et al. French Society of Cardiology guidelines on exercise tests (part 2): Indications for exercise tests in cardiac diseases. Arch Cardiovasc Dis. 2019. 112(1), 56-66, doi: 10.1016/j.acvd.2018.07.001.
7. Pritchard A, Burns P, Correia J, Jamieson P, et al. ARTP statement on cardiopulmonary exercise testing 2021. BMJ Open Respir Res. 2021. 8(1), e001121, doi: 10.1136/bmjresp-2021-001121.
8. William K, John B. A practical guide to the interpretation of cardiopulmonary exercise tests. Oxford University Press. 2014. 17-49.
9. Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation. 2011. 123(6), 668–680, doi: 10.1161/CIRCULATIONAHA.109.914788.
10. Poggio R, Arazi H.C, Giorgi M, Miriuka S.G. Prediction of severe cardiovascular events by VE/Vco2 slope versus peak Vo2 in systolic heart failure: A meta-analysis of the published literature. Am Heart J. 2010. 160(6), 1004–1014, doi: 10.1016/j.ahj.2010.08.037.
11. Arena R, Myers J, Abella J, et al. Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure. Circ Heart Fail. 2010. 3(3), 405–411, doi: 10.1161/CIRCHEARTFAILURE.109.906446.
12. Guazzi M, Arena R, Ascione A, Piepoli M, Guazzi M.D. Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value. Am Heart J. 2007. 153(5), 859–867, doi:
10.1016/j.ahj.2007.02.034.
13. Guazzi M, Myers J, Peberdy M.A, Bensimhon D, Chase P, Arena R. Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights. Eur Heart J. 2008. 29(22), 2751–2759, doi: 10.1093/eurheartj/ehn437.
14. Arena R, Lavie CJ, Milani R.V, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant. 2010. 29(2), 159–173, doi: 10.1016/j.healun.2009.09.003.
15. Arena R. Detecting abnormal pulmonary hemodynamics with cardiopulmonary exercise testing. Med Sci Sports Exerc. 2011. 43(6), 982, doi: 10.1249/MSS.0b013e31820e5fb3.
16. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the Factors Related to Mortality in Chronic Obstructive Pulmonary Disease: Role of Exercise Capacity and Health Status. Am J Respir Crit Care Med. 2003. 167(4), 544–549, doi: 10.1164/rccm.200206-583OC.
17. Gibbons R.J, Balady G.J, Timothy B.J, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise
Testing Guidelines). Circulation. 2002. 106(14), 1883–1892, doi:
10.1161/01.cir.0000034670.06526.15
18. Sharma S, Elliott P.M, Whyte G, et al. Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes. J Am Coll Cardiol. 2000. 36(3), 864–870, doi: 10.1016/s0735-1097(00)00816-0.
19. Sorajja P, Allison T, Hayes C, Nishimura R.A, Lam C.S.P, Ommen S.R. Prognostic Utility of Metabolic Exercise Testing in Minimally Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy. Am J Cardiol. 2012. 09(10), 1494-8. doi:
10.1016/j.amjcard.2012.01.363.
20. Pinkstaff S, Peberdy M.A, Fabiato A, Finucane S, Arena R. The clinical utility of cardiopulmonary exercise testing in suspected or confirmed myocardial ischemia. Am J Lifestyle Med. 2010. 4(4), 327–348, doi: 10.1177/1559827610362955.
21. Belardinelli R, Lacalaprice F, Carle F, et al. Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing. Eur Heart J. 2003. 24(14), 1304–1313, doi: 10.1016/s0195-668x(03)00210-0.
22. Cortina C, Sarrion C, Suberviola S, et al. Prognostic value of cardiopulmonary exercise testing in valvular heart disease, European Heart Journal, Volume 42, Issue Supplement_1, October 2021, ehab724.0126, doi: 10.1093/eurheartj/ehab724.0126.