Cardiopulmonary Exercise Testing

Boer, Esther de; Petrache, Irina; Mohning, Michael P.

doi:10.1001/jama.2022.2037

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…However, the sensitivity of exercise Doppler echocardiography for diagnosing HFpEF is 34% and the specificity is 83% (C statistic, 0.65) . An alternative test is cardiopulmonary exercise testing, which measures oxygen consumption and carbon dioxide production and can document the severity of exercise limitation in patients with dyspnea . The sensitivity of cardiopulmonary exercise testing using the peak oxygen consumption value that maximizes discrimination (<17 mL/kg/min) is 80% and the specificity is 76% (C statistic, 0.78) for the diagnosis of HFpEF, making cardiopulmonary exercise testing an inadequate tool for use in isolation …”

Section: Methodsmentioning

confidence: 99%

Heart Failure With Preserved Ejection Fraction

Redfield

Borlaug

2023

JAMA

228

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ImportanceHeart failure with preserved ejection fraction (HFpEF), defined as HF with an EF of 50% or higher at diagnosis, affects approximately 3 million people in the US and up to 32 million people worldwide. Patients with HFpEF are hospitalized approximately 1.4 times per year and have an annual mortality rate of approximately 15%.ObservationsRisk factors for HFpEF include older age, hypertension, diabetes, dyslipidemia, and obesity. Approximately 65% of patients with HFpEF present with dyspnea and physical examination, chest radiographic, echocardiographic, or invasive hemodynamic evidence of HF with overt congestion (volume overload) at rest. Approximately 35% of patients with HFpEF present with “unexplained” dyspnea on exertion, meaning they do not have clear physical, radiographic, or echocardiographic signs of HF. These patients have elevated atrial pressures with exercise as measured with invasive hemodynamic stress testing or estimated with Doppler echocardiography stress testing. In unselected patients presenting with unexplained dyspnea, the H2FPEF score incorporating clinical (age, hypertension, obesity, atrial fibrillation status) and resting Doppler echocardiographic (estimated pulmonary artery systolic pressure or left atrial pressure) variables can assist with diagnosis (H2FPEF score range, 0-9; score &gt;5 indicates more than 95% probability of HFpEF). Specific causes of the clinical syndrome of HF with normal EF other than HFpEF should be identified and treated, such as valvular, infiltrative, or pericardial disease. First-line pharmacologic therapy consists of sodium-glucose cotransporter type 2 inhibitors, such as dapagliflozin or empagliflozin, which reduced HF hospitalization or cardiovascular death by approximately 20% compared with placebo in randomized clinical trials. Compared with usual care, exercise training and diet-induced weight loss produced clinically meaningful increases in functional capacity and quality of life in randomized clinical trials. Diuretics (typically loop diuretics, such as furosemide or torsemide) should be prescribed to patients with overt congestion to improve symptoms. Education in HF self-care (eg, adherence to medications and dietary restrictions, monitoring of symptoms and vital signs) can help avoid HF decompensation.Conclusions and RelevanceApproximately 3 million people in the US have HFpEF. First-line therapy consists of sodium-glucose cotransporter type 2 inhibitors, exercise, HF self-care, loop diuretics as needed to maintain euvolemia, and weight loss for patients with obesity and HFpEF.

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Section: Methodsmentioning

confidence: 99%

Heart Failure With Preserved Ejection Fraction

Redfield

Borlaug

2023

JAMA

228

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“… 22 Cardiopulmonary exercise testing offers an objective and repeatable opportunity to determine the cause of exertional dyspnea and to calculate the degree of exercise capacity limitation. 20 , 23 In addition to aiding in the distinction between cardiovascular, pulmonary, and pulmonary vascular illnesses, it can also be useful in revealing the underlying, frequently intricate mechanisms. Therefore, CPET should be carried out prior to the patient undergoing a thorough diagnostic workup that looks for an anomaly that occurs while the patient is at rest and during exercise.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the clinical utilization of cardiopulmonary exercise testing in Saudi Arabia after 2 decades

Aldhahi,

Alqahtani,

AL-Hazzaa

2024

SMJ

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Objectives: To assess the prevalence of cardiopulmonary exercise testing (CPET) usage and identify barriers among major hospitals and medical centers in Saudi Arabia. We also aim to compare these findings with data from nearly 2 decades ago. Methods: In this cross-sectional study, 70 major hospitals and medical centers were contacted, and 52 (74.2%) responded. The participants involved in this study were healthcare providers proficient in carrying out CPET from different specialties. The survey comprised 21 items covering CPET utilization, exercise mode characteristics, common protocols, types of patients or disorders, and barriers to not carrying out CPET. Results: The majority (n=37; 71.9%) of the centers reported a lack of CPET utilization. Of the 15 centers that used CPET, only 11 carried out regular CPET. Cardiac-related conditions were the most commonly referred clinical cases (n=7), followed by pulmonary conditions and cardiopulmonary fitness. The common barriers to carrying out CPET have remained unchanged compared to 2 decades ago - that is, the lack of equipment or trained technicians. However, there has been a 14.1% increase in the utilization of CPET and a 10.1% increase in the use of treadmill mode compared to a survey carried out 2 decades ago. Conclusion: Although CPET utilization has increased over 2 decades, this still falls below the desired benchmark. This highlights the need for collaborative efforts among policymakers, and healthcare institutions to address barriers and improve CPET integration into clinical practice.

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“…Mounting evidence of dysregulated metabolism in PASC 91,105 should drive well‐powered future studies on the generic crosstalk between oxygen, lactate kinetics and mitochondrial function. Should such studies establish a strong evidence of mitochondrial dysfunction, then intervention strategies aimed at boosting mitochondrial function will become a priority area of research focus.…”

Section: Discussionmentioning

confidence: 99%

“…93 Recent studies on long COVID have reported myriads of dysregulated immune response including reduced level of neutralising antibodies, anti-spike antibodies and raised level of positive Anti-nuclear antibody titres [94][95][96] from possible protracted germinal centre dysfunction 95,97 ; reduced IgG3 at 6 months of follow-up 98 ; role of anti-idiotype antibodies 99 ; raised levels of activated CD8 þ T cells at 8 months in long COVID patients 100 which correlates with autoimmunity 101 and drives chronic inflammation. 102,103 Mounting evidence of dysregulated metabolism in PASC 91,105 should drive well-powered future studies on the generic crosstalk between oxygen, lactate kinetics and mitochondrial function. Should such studies establish a strong evidence of mitochondrial dysfunction, then intervention strategies aimed at boosting mitochondrial function will become a priority area of research focus.…”

Section: Mechanistic Insight and Clinical Significance Of Lactate Deh...mentioning

confidence: 99%

Lactate dehydrogenase contribution to symptom persistence in long COVID: A pooled analysis

Udeh,

Utrero‐Rico,

Dolja‐Gore

et al. 2023

Reviews in Medical Virology

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There's critical need for risk predictors in long COVID. This meta‐analysis evaluates the evidence for an association between plasma lactate dehydrogenase (LDH) and long COVID and explores the contribution of LDH to symptoms persistent across the distinct post‐acute sequelae of COVID‐19 (PASC) domains. PubMed, EMBASE, Web of Science, and Google Scholar were searched for articles published up to 20 March 2023 for studies that reported data on LDH levels in COVID‐19 survivors with and without PASC. Random‐effect meta‐analysis was employed to estimate the standardized mean difference (SMD) with corresponding 95% confidence interval of each outcome. There were a total of 8289 study participants (3338 PASC vs. 4951 controls) from 46 studies. Our meta‐analysis compared to the controls showed a significant association between LDH elevation and Resp‐PASC [SMD = 1.07, 95%CI = 0.72, 1.41, p = 0.01] but not Cardio‐PASC [SMD = 1.79, 95%CI = −0.02, 3.61, p = 0.05], Neuro‐PASC [SMD = 0.19, 95%CI = −0.24, 0.61, p = 0.40], and Gastrointestinal‐PASC [SMD = 0.45, 95%CI = −1.08, 1.98, p = 0.56]. This meta‐analysis suggests elevated LDH can be used for predicting Resp‐PASC, but not Cardio‐PASC, Neuro‐PASC or gastrointestinal‐PASC. Thus, elevated plasma LDH following COVID infection may be considered as a disease biomarker.

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Cardiopulmonary Exercise Testing

Cited by 6 publications

References 7 publications

Heart Failure With Preserved Ejection Fraction

Heart Failure With Preserved Ejection Fraction

Revisiting the clinical utilization of cardiopulmonary exercise testing in Saudi Arabia after 2 decades

Lactate dehydrogenase contribution to symptom persistence in long COVID: A pooled analysis

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