Cardiopulmonary exercise testing and second-line pulmonary function tests to detect obstructive pattern in symptomatic smokers with borderline spirometry

Clinical exercise testing has been used mainly to assess the cardiac response to exercise. Integrative cardiopulmonary exercise tests (CPET) involving the measurement of the ventilatory, circulatory and metabolic response to exercise has largely been a research tool. We analysed the results of one hundred tests randomly chosen from a total of 472 exercise tests performed between January 1992 and June 1993 as clinical investigation in a pulmonary function laboratory. CPET was used (a) to identify the cause of effort limitation in patients where more than one illness could be relevant (26); (b) to obtain an objective measure of the exercise capacity of patients with respiratory or cardiac disease (31); (c) as monitor of response to treatment (11) and (d) in the investigation of unexplained dyspnoea (32). In 94 of the 100 cases CPET was able to provide an answer to the specific clinical question posed. In patients with unexplained dyspnoea CPET identified a group who exhibit an inappropriate hyperventilatory response to exercise with no supportive evidence of cardiopulmonary disease. In a small minority of cases CPET gave non-specific results. We conclude that CPET is a useful investigation in the management of patients with cardiopulmonary disease and complements the various other investigations offered by a pulmonary function laboratory.

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Cardiopulmonary exercise testing and pulmonary function testing for predicting the severity of CTEPH

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01668-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hanqing Zhu ◽

Xingxing Sun ◽

Yuan Cao ◽

Bigyan Pudasaini ◽

Wenlan Yang ◽

...

Keyword(s):

Pulmonary Function ◽

Exercise Testing ◽

Predictive Value ◽

Minute Ventilation ◽

Cardiopulmonary Exercise Testing ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Function Testing ◽

Noninvasive Methods ◽

Cardiopulmonary Exercise ◽

Function Testing

Abstract Background Cardiopulmonary exercise testing (CPET) and pulmonary function testing (PFT) are noninvasive methods to evaluate the respiratory and circulatory systems. This research aims to evaluate and monitor chronic thromboembolic pulmonary hypertension (CTEPH) noninvasively and effectively by these two methods. Moreover, the research assesses the predictive value of CPET and PFT parameters for severe CTEPH. Methods We used data from 86 patients with CTEPH (55 for test set, and 31 for validation set) at the Shanghai Pulmonary Hospital Affiliated to Tongji University. The clinical, PFT and CPET data of CTEPH patients of different severity classified according to pulmonary artery pressure (PAP) (mm Hg) were collected and compared. Logistic regression analysis was performed to appraise the predictive value of each PFT and CPET parameter for severe CTEPH. The performance of CPET parameters for predicting severe CTEPH was determined by receiver operating characteristic (ROC) curves and calibration curves. Results Data showed that minute ventilation at anaerobic threshold (VE @ AT) (L/min) and oxygen uptake at peak (VO2 @ peak) (mL/kg/min) were independent predictors for severe CTEPH classified according to PAP (mm Hg). Additionally, the efficacy of VE @ AT (L/min) and VO2 @ peak (mL/kg/min) in identifying severe CTEPH was found to be moderate with the area under ROC curve (AUC) of 0.769 and 0.740, respectively. Furthermore, the combination of VE @ AT (L/min) and VO2 @ peak (mL/kg/min) had a moderate utility value in identifying severe CTEPH with the AUC of 0.843. Conclusion Our research suggests that CPET and PFT can noninvasively and effectively evaluate, monitor and predict the severity of CTEPH.

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Cardiopulmonary exercise testing in interstitial lung diseases and the value of ventilatory efficiency

European Respiratory Review ◽

10.1183/16000617.0355-2020 ◽

2021 ◽

Vol 30 (162) ◽

pp. 200355

Author(s):

Thomas Gille ◽

Pierantonio Laveneziana

Keyword(s):

Exercise Testing ◽

Lung Diseases ◽

Pulmonary Function Tests ◽

Cardiopulmonary Exercise Testing ◽

Interstitial Lung Diseases ◽

Prognostic Information ◽

Ventilatory Efficiency ◽

Cardiopulmonary Exercise ◽

Peripheral Muscle ◽

Exercise Adaptation

Interstitial lung diseases (ILDs) are diverse parenchymal pulmonary disorders, primarily characterised by alveolar and interstitial inflammation and/or fibrosis, and sharing pathophysiological similarities. Thus, patients generally harbour common respiratory symptoms, lung function abnormalities and modified exercise adaptation. The most usual and disabling complaint is exertional dyspnoea, frequently responsible for premature exercise interruption. Cardiopulmonary exercise testing (CPET) is increasingly used for the clinical assessment of patients with ILD. This is because exercise performance or dyspnoea on exertion cannot reliably be predicted by resting pulmonary function tests. CPET, therefore, provides an accurate evaluation of functional capacity on an individual basis. CPET can unmask anomalies in the integrated functions of the respiratory, cardiovascular, metabolic, peripheral muscle and neurosensory systems in ILDs. CPET uniquely provides an evaluation of all above aspects and can help clinicians shape ILD patient management. Preliminary evidence suggests that CPET may also generate valuable prognostic information in ILDs and can be used to shed light on the presence of associated pulmonary hypertension. This review aims to provide comprehensive and updated evidence concerning the clinical utility of CPET in ILD patients, with particular focus on the physiological and clinical value of ventilatory efficiency (V˙E/V˙CO2).

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