01 Feb Exercise Physiology and Cardiopulmonary Exercise Testing (CPET) in Respiratory Disorders
Invasive cardiopulmonary exercise testing in the evaluation of unexplained dyspnoea: Insights from a multidisciplinary dyspnoea centre
Unexplained dyspnoea is a common diagnosis that often results in repeated diagnostic testing and even delayed treatments while a determination of the cause is being investigated. Through a retrospective study, this study evaluated the diagnostic efficacy of a multidisciplinary dyspnoea evaluation centre (MDEC) using invasive cardiopulmonary exercise test (CPET) to diagnose potential causes of unexplained dyspnoea. During the study 530 patients underwent investigation with invasive cardiopulmonary exercise test with results showing the time from initial presentation to referral was significantly longer than time to diagnosis after referral for non-standardized conventional methods versus diagnosis through MDEC using invasive cardiopulmonary exercise test (511 days (292–1095 days) vs. 27 days (13–53 days), p < 0.0001). As a result of this retrospective study, the researchers concluded that a multidisciplinary approach that includes invasive cardiopulmonary exercise test dramatically reduces the time to diagnosis compared with traditional treatment and testing methods.
Wei H, Resch S, Oliveira R, Cockrill B, Systrom DM, Waxman A. Invasive cardiopulmonary exercise testing in the evaluation of unexplained dyspnoea: Insights from a multidisciplinary dyspnoea centre. European Journal of Preventive Cardiology. Vol 24, Issue 11, pp. 1190 – 1199. First published date: May-16-2017.
Prognostic Role of Cardiopulmonary Exercise Testing in Clinical Practice
Risk stratification is a mainstay in the care of cardiac and pulmonary disorders, as the identification of adverse outcomes helps provide measures to improve survival and quality of life. The cardiopulmonary exercise test is a useful prognostic tool in the clinical evaluation of several pathological conditions, such as heart diseases, respiratory disorders, and pulmonary hypertension. If not contraindicated, a cardiopulmonary exercise test should always be performed and integrated with clinical, laboratory, and hemodynamic parameters to better stratify patient risk. In respiratory disorders and in pulmonary hypertension, cardiopulmonary exercise test parameters, focusing on ventilatory performance during exercise, may help evaluate the risk of adverse events. Regarding exercise, peak V.O2 maintains its prognostic power in chronic obstructive pulmonary disease as in other pathological conditions. However, two other abnormalities of ventilatory function during exercise are important: ventilation at peak exercise and exercise-induced hypoxemia, both of which are assessed during CPET. In patients suffering from respiratory disorders, an integrated analysis of resting lung function, blood gas, and cardiopulmonary exercise test parameters can be considered the best way to predict adverse outcomes and to grade the severity of the disease.
Paolillo S, Agostoni P. Prognostic role of Cardiopulmonary Exercise Testing in Clinical Practice. Ann Am Thoracic Society. 2017 July.
Cardiopulmonary exercise testing for detecting pulmonary arterial hypertension in systemic sclerosis
Pulmonary arterial hypertension (PAH) is a devastating disease with limited survival and occurs as a frequent complication in patients with systemic sclerosis (SSc). A definite diagnosis of PAH is obtained by right heart catheterisation (RHC); however, the initial suspicion is raised by non-invasive methods. This study assessed the diagnostic accuracy of key parameters derived from cardiopulmonary exercise testing (CPET) for detecting and ruling out SSc-associated PAH. RHC identified PAH in 48 patients (27.8%), postcapillary pulmonary hypertension (PH) in 10 patients (5.8%) and ruled out PH in 115 patients (66.5%). CPET parameters correlated significantly with pulmonary haemodynamic. PeakVO2 and VE/VCO2 showed highest correlations with pulmonary arterial pressure, transpulmonary pressure gradient and pulmonary vascular resistance. Several parameters showed high sensitivity and specificity for PAH detection by receiver operating characteristic analysis. The researchers stated CPET is a safe and valuable method in the non-invasive detection of SSc-associated PAH. It may be particularly beneficial for reducing unnecessary RHC procedures.