CHRONOTROPIC INSUFFICIENCY AS CAUSE OF EXERCISE LIMITATION IN PATIENTS UNDERGOING CARDIOPULMONARY EXERCISE TESTING FOR DYSPNEA

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

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The Role of Cardiopulmonary Exercise Test in IPF Prognosis

Pulmonary Medicine ◽

10.1155/2013/514817 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 15

Author(s):

Christina Triantafillidou ◽

Effrosyni Manali ◽

Panagiotis Lyberopoulos ◽

Likourgos Kolilekas ◽

Konstantinos Kagouridis ◽

...

Keyword(s):

Oxygen Consumption ◽

Exercise Testing ◽

Risk Estimation ◽

Minute Ventilation ◽

Cardiopulmonary Exercise Testing ◽

Lung Mechanics ◽

Peak Oxygen Consumption ◽

Exercise Limitation ◽

Cardiopulmonary Exercise

Background. In IPF, defects in lung mechanics and gas exchange manifest with exercise limitation due to dyspnea, the most prominent and disabling symptom.Aim. To evaluate the role of exercise testing through the 6MWT (6-minute walk test) and CPET (cardiopulmonary exercise testing) in the survival of patients with IPF.Methods. This is a prospective, observational study evaluating in 25 patients the relationship between exercise variables through both the 6MWT and CPET and survival.Results. By the end of the observational period 17 patients were alive (33% mortality). Observation ranged from 9 to 64 months. VE/VCO2slope (slope of relation between minute ventilation and CO2production), VO2peak/kg (peak oxygen consumption/kg), VE/VCO2ratio at anaerobic threshold, 6MWT distance, desaturation, and DLCO% were significant predictors of survival while VE/VCO2slope and VO2peak/kg had the strongest correlation with outcome. The optimal model for mortality risk estimation was VO2peak/kg + DLCO% combined. Furthermore, VE/VCO2slope and VO2peak/kg were correlated with distance and desaturation during the 6MWT.Conclusion. The integration of oxygen consumption and diffusing capacity proved to be a reliable predictor of survival because both variables reflect major underlying physiologic determinants of exercise limitation.

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Utility of Cardiopulmonary Exercise Testing (CPET) in the Post-COVID-19 Context: Retrospective Analysis of a Single Centre Experience.

10.21203/rs.3.rs-537361/v1 ◽

2021 ◽

Author(s):

Edward Parkes ◽

Joanna Shakespeare ◽

Timothy Robbins ◽

Ioannis Kyrou ◽

Harpal Randeva ◽

...

Keyword(s):

Exercise Testing ◽

Objective Assessment ◽

Cardiopulmonary Exercise Testing ◽

Clinical Information ◽

Pulmonary Vascular Disease ◽

Single Centre ◽

Exercise Limitation ◽

Cardiopulmonary Exercise ◽

Single Centre Experience ◽

Single Centre Study

Abstract Cardiopulmonary exercise testing (CPET) allows objective assessment of a patient’s global response to maximal incremental exercise. CPET has been proposed to have a role in investigating post-COVID syndrome. However, CPET is resource intensive, and essential for restoration of other clinical services (e.g. cancer surgery). The aim of this study was to explore utility of CPET in assessing functional status of COVID-19 survivors with persistent dyspnoea. Of the 600 patients reviewed in a post-COVID-19 assessment clinic between May 2020 and April 2021, 12 (male/female: 8/4; age: 4±15.2 years; BMI: 32.8±5.9 kg/m2; non-smokers/ smokers: 8/4) were referred for CPET due to persistent breathlessness out-keeping with disease severity. Of these patients, 10 patients demonstrated reduced peak VO2, whilst five had an exercise limitation attributed to physical deconditioning. Two patients had mainly a cardiac limitation to exercise, with a further three patients demonstrating breathing pattern disorder, pulmonary vascular disease and lung disease. The findings of this single-centre study suggest that intensive CPET testing may not add substantial additional clinical information to aid patient investigation/management in the context of post-COVID. Such resource intensive procedures may be better utilised in selected patients and in the restoration of NHS services following the COVID-19 pandemic.

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Limited Exercise Capacity in Patients with Systemic Sclerosis: Identifying Contributing Factors with Cardiopulmonary Exercise Testing

The Journal of Rheumatology ◽

10.3899/jrheum.161349 ◽

2017 ◽

Vol 45 (1) ◽

pp. 95-102 ◽

Cited By ~ 3

Author(s):

Nihal Martis ◽

Viviane Queyrel-Moranne ◽

David Launay ◽

Rémi Neviere ◽

Jean-Gabriel Fuzibet ◽

...

Keyword(s):

Systemic Sclerosis ◽

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Volume Ratio ◽

Significant Negative Correlation ◽

Left Ventricular ◽

Heart Catheterization ◽

Contributing Factors ◽

Exercise Limitation ◽

Cardiopulmonary Exercise

Objective.Exercise limitation in patients with systemic sclerosis (SSc) is often multifactorial and related to complications such as interstitial lung disease (ILD), pulmonary vasculopathy (PV), left ventricular dysfunction (LVD), and/or peripheral/muscular limitation (PML). We hypothesized that cardiopulmonary exercise testing (CPET) could not only suggest and rank competing etiologies, but also highlight peripheral impairment.Methods.Clinical, resting pulmonary function testing, and CPET data from patients with SSc referred for exercise limitation between October 2009 and November 2015 were retrospectively analyzed in this bi-center study. Patients were categorized as having ILD, PV, LVD, and/or PML based on CPET response patterns and the diagnoses were matched with results from the reference investigations. The latter consisted of transthoracic echocardiography, chest computed tomography scan, and right heart catheterization (RHC).Results.Twenty-seven patients presented with CPET profiles consistent with ILD (n = 16), PV (n = 15), LVD (n = 5), and PML (n = 19). None of the subjects had a normal CPET profile. There was a statistically significant negative correlation between resting DLCO, on the one hand, and dead space to tidal volume ratio and alveolar–arterial gradient [P(Ai-a)O2] on the other (p < 0.005). CPET identified 90% of patients with a mean pulmonary arterial pressure at rest ≥ 21 mmHg measured by RHC (n = 10). Peak P(Ai-a)O2, taken independently from other variables, was crucial in distinguishing subjects with ILD from those without ILD (p < 0.05).Conclusion.CPET is useful for the characterization of multifactorial exercise limitation in patients with SSc and in identifying SSc-related complications such as ILD and PV. This study also identifies PML as an underestimated cause of exercise limitation.

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Evaluation of dyspnea of unknown etiology in HIV patients with cardiopulmonary exercise testing and cardiovascular magnetic resonance imaging

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-020-00664-6 ◽

2020 ◽

Vol 22 (1) ◽

Author(s):

Andrew J. Patterson ◽

Anuja Sarode ◽

Sadeer Al-Kindi ◽

Lauren Shaver ◽

Rahul Thomas ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Pulmonary Artery ◽

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Left Ventricular ◽

Hiv Patients ◽

Exercise Limitation ◽

Cardiopulmonary Exercise ◽

Exercise Induced

Abstract Aim Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. Methods and results Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO2) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO2 slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO2 measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO2 (p = 0.02, p = 0.03). Conclusion Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.

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S25 Cardiopulmonary exercise testing to evaluate exercise limitation and shortness of breath in long COVID

10.1136/thorax-2021-btsabstracts.31 ◽

2021 ◽

Author(s):

L Godinho ◽

A Freeman

Keyword(s):

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Shortness Of Breath ◽

Exercise Limitation ◽

Cardiopulmonary Exercise

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Cardiopulmonary exercise test

ESC Handbook of Cardiovascular Rehabilitation ◽

10.1093/med/9780198849308.003.0018 ◽

2020 ◽

pp. 151-162

Author(s):

Luca Moderato ◽

Massimo Francesco Piepoli

Keyword(s):

Heart Failure ◽

Decision Making ◽

Exercise Testing ◽

Global Assessment ◽

Cardiopulmonary Exercise Testing ◽

Cardiopulmonary Exercise Test ◽

Metabolic Responses ◽

Exercise Limitation ◽

Cardiopulmonary Exercise ◽

Process And Outcome

Cardiopulmonary exercise testing (CPET) is a safe and reproducible diagnostic tool for the global assessment of cardiovascular (CV), ventilatory, and metabolic responses to exercise. It can be extremely useful for understanding the reasons for dyspnoea, fatigue, and exercise limitation, and for differentiating between cardiac and pulmonary disorders. CPET can also help the clinician to optimize the decision-making process and outcome prediction, especially in heart failure (HF) patients.

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Multivariate Criteria Most Accurately Distinguish Cardiac from Noncardiac Causes of Dyspnea

Texas Heart Institute Journal ◽

10.14503/thij-14-4373 ◽

2015 ◽

Vol 42 (6) ◽

pp. 514-521 ◽

Cited By ~ 1

Author(s):

Mirza Nubair Ahmad ◽

Syed Hasan Yusuf ◽

Rafath Ullah ◽

Mirza Mujadil Ahmad ◽

Mary K. Ellis ◽

...

Keyword(s):

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Peak Stress ◽

Continuous Measure ◽

Curve Pattern ◽

Abnormal Result ◽

Exercise Limitation ◽

Cardiopulmonary Exercise ◽

Oxygen Pulse ◽

Arterial Blood

Cardiopulmonary exercise testing provides oxygen pulse as a continuous measure of stroke volume, which is superior to other stress-testing methods in which systolic function is measured at baseline and at peak stress. However, the optimal peak oxygen pulse criterion for distinguishing cardiac from noncardiac causes of exercise limitation is unknown. In comparing several peak oxygen pulse criteria against the clinical standard of cardiopulmonary exercise testing, we retrospectively studied 54 consecutive patients referred for cardiopulmonary exercise testing. These exercise tests included measurement of oxygen consumption, carbon dioxide production, breathing reserve, arterial blood gases at baseline and at peak stress, exercise electrocardiogram, heart rate, and blood pressure response. Results were blindly interpreted and patients were categorized as members either of our Cardiac Group (abnormal result secondary to cardiac causes of exercise limitation) or of our Noncardiac Group (normal or abnormal result secondary to any noncardiac cause of exercise limitation). The accuracy of the peak oxygen pulse criteria ranged from 50% for univariate criterion (≤15 mL/beat), to 61% for oxygen pulse curve pattern, to 63% for bivariate criterion (≤15 mL/beat for men, ≤10 mL/beat for women), to as high as 81% for a multivariate criterion. All multivariate criteria outperformed oxygen pulse curve pattern, univariate, and bivariate criteria. This is the first study to evaluate the optimal peak oxygen pulse criterion for differentiating cardiac from noncardiac causes of exercise limitation. Multivariate criteria (especially a criterion incorporating age, sex, height, and weight) should be used preferentially, as opposed to the commonly used univariate and bivariate criteria.

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