Cardiopulmonary exercise tests

Fig. 4.2 In Panel A, the effects of CRT on NYHA class is shown for three trials, all of which shared similar entry criteria and a 6-month randomized, double-blind study duration. In each graphic, control (no CRT) is represent in open boxes and patient treated with CRT (CRT) in hashed boxes. Panel B represents the effect of CRT on 6-min hall walk distance and Panel C represents the peak oxygen consumption on cardiopulmonary exercise testing...

ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med 2003 167 211-277. 

Myers J, Gullestad L, Vagelos R, et al. Clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients referred for evaluation of heart failure. Ann Intern Med 1998 129 286-93. 

Miyamoto S, Nagaya N, Satoh T, et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 1999 161 487-92. 

Weber KT, Janicki IS. Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol 1985 5S 22A. 

Alterations in cardiopulmonary exercise tests (CPET) have been noted in 28% to 47% of patients with sarcoidosis (6,63,65,66). Typical findings include ventilatory limitation or increased dead space/tidal volume ratio (Vd/Vx) or widened alveolar-arterial O2 (A-a O2) gradient with exercise (63,65). CPET may be abnormal when static PFTs are normal (63,67). Exercise-induced desaturation correlated with reductions in DLco (63,68-70), whereas lung volumes and expiratory flow rates did not (70). 

Schwaiblmair M, Beinert T, Vogelmeier C, et al. Cardiopulmonary exercise testing following hay exposure challenge in farmer s lung. Eur Respir J 1997 10 (10) 2360-2365. 

Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, Forman D 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. 

For the growing number of patients with combined pulmonary hypertension and abnormal left ventricular hemodynamics, a careful hemodynamic study can help to delineate the subtleties of both diseases and response to therapies. Exercise catheterization is recommended in those patients with normal hemodynamics at rest, but with a pretest likelihood of PAH and/or other data suggesting exercise-induced symptoms, for instance, exercise echo or cardiopulmonary stress test. Unfortunately, to date there is no consensus as to the best exercise protocols for an appropriate hemodynamic assessment. Among those used include upright bicycle with neck pulmonary arterial (PA) lines at 75% predicted maximum exercise, supine bicycle, supine arm exercise, and supine volume loading. In all cases, it is essential to carefully measure PCWP, cardiac outputs, and PA pressures at consistent parts of the respiratory cycle, and not merely PA pressures. 

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