scholarly journals Cardiopulmonary Exercise Testing in the Evaluation of Unexplained Dyspnea

2010 ◽  
Vol 9 (2) ◽  
pp. 101-106
Author(s):  
William M. Oldham ◽  
David M. Systrom
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Testing ◽  
Massachusetts General Hospital ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Stress ◽  
Exertional Dyspnea ◽  
Cardiopulmonary Exercise ◽  
Invasive Hemodynamic Monitoring ◽  
Pulmonary Arterial ◽  
Exercise Induced

Diagnosis of unexplained exertional dyspnea or fatigue is a significant challenge. When routine cardiac and pulmonary evaluations are unrevealing, cardiopulmonary exercise testing (CPET) with invasive hemodynamic monitoring may reveal the abnormal physiology causing these symptoms. In this review, the authors describe the protocol for invasive CPET at Massachusetts General Hospital, and present cases of exercise-induced pulmonary arterial hypertension and exercise-induced heart failure with preserved ejection fraction, as well as a new entity, preload failure, to demonstrate the utility of invasive CPET in the evaluation of unexplained exertional dyspnea. Indeed, exercise-induced pulmonary hypertension may represent early disease where prompt therapeutic intervention may improve outcome. When compared to noninvasive CPET or exercise stress echocardiography, invasive CPET has significant advantages in identifying the etiology of elevated pulmonary pressures and determining the influence of central hemodynamics on exercise capacity. For this reason, we expect that invasive CPET will assume a more prominent role in the evaluation and management of pulmonary hypertension.

scholarly journals Motor Pathophysiology Related to Dyspnea in COPD Evaluated by Cardiopulmonary Exercise Testing

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 364
Author(s):  
Keisuke Miki
Keyword(s):  
Exercise Testing ◽  
Systemic Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Treatment Strategies ◽  
Chronic Obstructive ◽  
Exertional Dyspnea ◽  
Obstructive Pulmonary Disease ◽  
Medicine Department ◽  
Cardiopulmonary Exercise ◽  
Dynamic Lung Hyperinflation

In chronic obstructive pulmonary disease (COPD), exertional dyspnea, which increases with the disease’s progression, reduces exercise tolerance and limits physical activity, leading to a worsening prognosis. It is necessary to understand the diverse mechanisms of dyspnea and take appropriate measures to reduce exertional dyspnea, as COPD is a systemic disease with various comorbidities. A treatment focusing on the motor pathophysiology related to dyspnea may lead to improvements such as reducing dynamic lung hyperinflation, respiratory and metabolic acidosis, and eventually exertional dyspnea. However, without cardiopulmonary exercise testing (CPET), it may be difficult to understand the pathophysiological conditions during exercise. CPET facilitates understanding of the gas exchange and transport associated with respiration-circulation and even crosstalk with muscles, which is sometimes challenging, and provides information on COPD treatment strategies. For respiratory medicine department staff, CPET can play a significant role when treating patients with diseases that cause exertional dyspnea. This article outlines the advantages of using CPET to evaluate exertional dyspnea in patients with COPD.

Reproducibility of Inert Gas Rebreathing Method to Estimate Cardiac Output at Rest and During Cardiopulmonary Exercise Stress Testing

2019 ◽  
Vol 40 (02) ◽  
pp. 125-132 ◽  
Author(s):  
Nduka Okwose ◽  
Jie Zhang ◽  
Shakir Chowdhury ◽  
David Houghton ◽  
Srdjan Ninkovic ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Exercise Testing ◽  
Coefficient Of Variation ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Stress ◽  
Inert Gas ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Inert Gas Rebreathing ◽  
Rebreathing Method

AbstractThe present study evaluated reproducibility of the inert gas rebreathing method to estimate cardiac output at rest and during cardiopulmonary exercise testing. Thirteen healthy subjects (10 males, 3 females, ages 23–32 years) performed maximal graded cardiopulmonary exercise stress test using a cycle ergometer on 2 occasions (Test 1 and Test 2). Participants cycled at 30-watts/3-min increments until peak exercise. Hemodynamic variables were assessed at rest and during different exercise intensities (i. e., 60, 120, 150, 180 watts) using an inert gas rebreathing technique. Cardiac output and stroke volume were not significantly different between the 2 tests at rest 7.4 (1.6) vs. 7.1 (1.2) liters min−1, p=0.54; 114 (28) vs. 108 (15) ml beat−1, p=0.63) and all stages of exercise. There was a significant positive relationship between Test 1 and Test 2 cardiac outputs when data obtained at rest and during exercise were combined (r=0.95, p<0.01 with coefficient of variation of 6.0%), at rest (r=0.90, p<0.01 with coefficient of variation of 5.1%), and during exercise (r=0.89, p<0.01 with coefficient of variation 3.3%). The mean difference and upper and lower limits of agreement between repeated measures of cardiac output at rest and peak exercise were 0.4 (−1.1 to 1.8) liter min−1 and 0.5 (−2.3 to 3.3) liter min−1, respectively. The inert gas rebreathing method demonstrates an acceptable level of test-retest reproducibility for estimating cardiac output at rest and during cardiopulmonary exercise testing at higher metabolic demands.

scholarly journals Correlation Between N-Terminal Pro-Brain Natriuretic Peptide Levels and Cardiopulmonary Exercise Testing in Patients With Pre-Capillary Pulmonary Hypertension: A Pilot Study

2020 ◽  
Vol 14 ◽  
pp. 117954842095404
Author(s):  
Sahachat Aueyingsak ◽  
Wilaiwan Khrisanapant ◽  
Upa Kukongviriyapun ◽  
Orapin Pasurivong ◽  
Pailin Ratanawatkul ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Pulmonary Hypertension ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise ◽  
End Tidal

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiopulmonary exercise testing (CPET) are useful for severity assessment in patients with pulmonary hypertension (PH). Correlations between these tests in pre-capillary PH patients is less well studied. Methods: We studied 23 patients with pre-capillary PH: 8 with idiopathic pulmonary arterial hypertension (IPAH), 6 with systemic sclerosis-associated PAH (SSc-PAH), and 9 with chronic thromboembolic pulmonary hypertension (CTEPH). Clinical evaluation, NT-proBNP levels, six-minute walking test (6MWT), spirometry, and CPET were evaluated on the same day. Correlation between NT-proBNP levels and CPET parameters were investigated. Results: In all patients, NT-proBNP levels were significantly correlated with peak oxygen uptake (VO2) ( r = −0.47), peak oxygen pulse ( r = −0.43), peak cardiac output (CO) ( r = −0.57), peak end-tidal partial pressure of carbon dioxide (PETCO2) ( r = −0.74), ventilatory equivalent to carbon dioxide (VE/VCO2) at anaerobic threshold (AT) ( r = 0.73), and VE/VCO2 slope ( r = 0.64). Significant correlations between NT-proBNP levels and peak PETCO2 and VE/VCO2 were found in IPAH and CTEPH subgroups, and a significant correlation between NT-proBNP levels and VO2 at AT was found in the CTEPH subgroup. No significant correlation was found in the SSc-PAH subgroup. Conclusion: NT-proBNP levels were significantly correlated with CPET parameters in patients with IPAH and CTEPH subgroups, but not in SSc-PAH subgroup. A further study with larger population is required to confirm these preliminary findings.

scholarly journals Exercise-Induced Myocardial Ischemia Detected by Cardiopulmonary Exercise Testing

2009 ◽  
Vol 103 (5) ◽  
pp. 615-619 ◽  
Author(s):  
Sundeep Chaudhry ◽  
Ross Arena ◽  
Karlman Wasserman ◽  
James E. Hansen ◽  
Gregory D. Lewis ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise ◽  
Exercise Induced
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