APPLICATION OF CARDIOPULMONARY EXERCISE IN CARDIOVASCULAR DISEASE
Main Article Content
Abstract
Despite advances in technologies related to diagnostic testing and the popularity of imaging techniques, assessment of exercise responses provides critical enhancement of the evaluation of patients with or suspected of having cardiovascular or pulmonary disease. CPET is a comprehensive, noninvasive assessment of the cardiovascular, respiratory and musculoskeletal systems response to exercise. CPET may provide detailed insights into cardiac function, enhancing both diagnostic precision and the ability to predict adverse cardiovascular events through parameters like VO2 peak and VE/VCO2 slope. This review analyses the value of CPET in diagnosis and management cardiovascular disease in clinical practice. This review also aims to inform clinicians about its main indications, applications, and basic interpretation in cardiovascular disease.
Keywords
CPET, Cardiopulmonary exercise testing, cardiovascular disease
Article Details
References
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.