The role of cardiopulmonary exercise tests in pulmonary arterial hypertension

Farina, Stefania; Correale, Michele; Bruno, Noemi; Paolillo, Stefania; Salvioni, Elisabetta; Badagliacca, Roberto; Agostoni, Piergiuseppe

doi:10.1183/16000617.0134-2017

Cited by 64 publications

(62 citation statements)

References 61 publications

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“…Determining the V′ E /V′ CO 2 slope provides relevant information especially for patients with pulmonary hypertension and heart failure [155,156]. Other relationships such as V′ O 2 /work rate and V′ O 2 divided by HR (=oxygen pulse) are also helpful in assessing patients with (suspected) cardiac or vascular disease [30].…”

Section: Infection Control Considerationsmentioning

confidence: 99%

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

et al. 2019

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The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.

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Section: Infection Control Considerationsmentioning

confidence: 99%

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

et al. 2019

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“…In addition, clues can be provided regarding the relative roles for abnormalities in gas exchange (low SpO 2 ), wasted ventilation (high V E/ V CO 2 ), or abnormalities in the O 2 pulse (V O 2 /HR) which may reflect a limitation in right ventricular (RV) stroke volume, the ability to enhance arteriovenous difference during stress, or some combination of both. These patterns have been reviewed extensively, in both the PAH [24][25][26] and heart failure literature. 27 nCPET has met with limited success in the diagnosis of PVD in patients with dyspnea of unknown origin (DUO).…”

Section: Methodsologymentioning

confidence: 99%

Tools of the Trade: How Do You Perform and Interpret an Exercise Test?

Rischard

Borlaug

2019

Advances in Pulmonary Hypertension

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Background: Most pulmonary vascular disease (PVD) is poorly modifiable and incurable even with effective therapy. Therefore, adaptation to stress, the reserve of the cardiopulmonary system, is important for assessment of patient function and prognosis. Methods that assess the adaptation to stress, especially exercise, provide valuable insight into diagnosis, prognosis, and response to therapy. Implications for Clinicians: We provide a comprehensive review of the indications, methodology, and interpretation, as well as practical information of the forms of provocative testing in PVD. We include 6-minute walk testing, noninvasive cardiopulmonary exercise testing (CPET), invasive CPET, and additional forms, including volume loading. Conclusions: Through a clear understanding of the methodology in the assessment of PVD, the clinician can determine which of these "tools of the trade" are best suited to the individual patient and situation.

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“…During CPET, gas exchange abnormalities are related to alveolar hypoperfusion relative to ventilation. With exercise, PAH is characterized by a moderate to severe reduction in peak oxygen uptake (⩒O 2 ), high physiological dead space (V D /V T ), impaired perfusion (lower end‐tidal carbon dioxide (P ET CO 2 )), reduced anaerobic threshold (AT) and inefficient ventilation (increased ⩒e/⩒CO 2 ) . Patients with CTEPH have proximal vascular obstruction resulting in poor right ventricle–pulmonary artery coupling and worse gas exchange compared to PAH.…”

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confidence: 99%