scholarly journals Cardiopulmonary Exercise Testing in Patients with Asymptomatic or Equivocal Symptomatic Aortic Stenosis: Feasibility, Reproducibility, Safety and Information Obtained on Exercise Physiology

Cardiology ◽  
2015 ◽  
Vol 133 (3) ◽  
pp. 147-156 ◽  
Author(s):  
Douet van Le ◽  
Gunnar Vagn Hagemann Jensen ◽  
Steen Carstensen ◽  
Lars Kjøller-Hansen
Keyword(s):  
Aortic Stenosis ◽  
Stroke Volume ◽  
Valve Replacement ◽  
Exercise Testing ◽  
Comprehensive Evaluation ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Aortic Valve Area ◽  
Cardiopulmonary Exercise ◽  
O2 Pulse

Objective: The aim of this study was to determine the feasibility, reproducibility, safety and information obtained on exercise physiology from cardiopulmonary exercise testing (CPX) in patients with aortic stenosis. Methods: Patients with an aortic valve area (AVA) <1.3 cm2 who were judged asymptomatic or equivocal symptomatic underwent CPX and an inert gas rebreathing test. Only those where comprehensive evaluation of CPX results indicated haemodynamic compromise from aortic stenosis were referred for valve replacement. Results: The mean patient age was 72 (±9) years; an AVA index <0.6 cm2/m2 and equivocal symptomatic status were found in 90 and 70%, respectively. CPX was feasible in 130 of the 131 patients. The coefficients of repeatability by test-retest were 5.4% (pVO2) and 4.6% (peak O2 pulse). A pVO2 <83% of the expected was predicted by a lower stroke volume at exercise, lower peak heart rate and FEV1, and higher VE/VCO2, but not by AVA index. Equivocal symptomatic status and a low gradient but high valvulo-arterial impedance were associated with a lower pVO2, but not with an inability to increase stroke volume. In total, 18 patients were referred for valve replacement. At 1 year, no cardiovascular deaths had occurred. Conclusions: CPX was feasible and reproducible and provided comprehensive data on exercise physiology. A CPX-guided treatment strategy was safe up to 1 year.

Abstract 16788: Cardiopulmonary Exercise Testing in Pulmonary Atresia With Intact Ventricular Septum

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Krishan Patel ◽  
Andrew L Cheng ◽  
Andrew Souza ◽  
Arash Sabati ◽  
Jon A Detterich
Keyword(s):  
Stroke Volume ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Pulmonary Atresia ◽  
Wilcoxon Test ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
O2 Pulse

Introduction: Pulmonary atresia with intact ventricular septum (PAIVS) is surgically managed with biventricular repair (2V), 1.5 ventricle palliation (1.5V), or single ventricle palliation (1V). Cardiopulmonary exercise testing (CPET) has been increasingly utilized in these patients. However, prognostic ability of CPET is limited by achievement of maximal exercise effort [respiratory exchange ratio (RER) > 1.1]. Even during submaximal exercise, the VE/VCO2 can impact peak VO2. This study aims to identify CPET differences in 1V, 1.5V, and 2V PAIVS patients. Methods: A retrospective, cross-sectional study was performed, identifying PAIVS patients undergoing CPET. Contemporaneous echocardiography and CMR data was collected. CPET measures were compared by treatment group using ANOVA, Kruskal-Wallis, and chi-squared test, as appropriate. Comparisons of VE/VCO2 between individual groups were performed using Wilcoxon test. Univariate associations with VE/VCO2 were determined using Pearson correlation. Results: Nineteen PAIVS patients were identified (age 12.4 ± 0.68; seven 1V, five 1.5V, seven 2V). Only 7/19 (36.8%) patients achieved RER > 1.1. Sex, age, RER, peak VO2, ventilatory anaerobic threshold, O2 pulse, BSA-adjusted O2 pulse, peak HR, and HR reserve did not differ between treatment groups. The VE/VCO2 ratio was different (p=0.037), with lower VE/VCO2 in 1.5V vs. 1V (p=0.021). Across all PAIVS patients, univariate associations with lower VE/VCO2 were male sex, higher BSA, hematocrit, and O2 pulse, and lower mitral inflow A wave velocity. In the 1.5V and 2V patients, higher RVEF and RV stroke volume by CMR were associated with lower VE/VCO2. Conclusions: The 1.5V palliation of PAIVS may be associated with better gas exchange efficiency compared to 1V palliation, while 2V patients were not different from either 1V or 1.5V. BSA-adjusted O2 pulse did not vary between treatment pathways, suggesting similar stroke volume response across all patients.

Cardiopulmonary Exercise Testing

2018 ◽  
pp. 413-436
Author(s):  
Andrew Kao
Keyword(s):  
Exercise Testing ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Gas Analysis ◽  
Peak Oxygen Consumption ◽  
Normative Values ◽  
Cardiopulmonary Exercise ◽  
Expired Gas Analysis ◽  
Expired Gas

The chapter Cardiopulmonary Exercise Testing focuses on the opportunities provided by cardiopulmonary exercise (CPX) testing. The coordination of 5 organ systems is described in normal exercise physiology to understand abnormal exercise findings. From a few measured expired gas analysis parameters, most of the important exercise variables can be derived, including the peak oxygen consumption (peak VO2). The contribution of both the aerobic and anaerobic phases of exercise to total exercise capacity are described, including the methods for determination of the anaerobic threshold. The calculation of the normative values of peak VO2 are included, and a suggested template of a CPX report is included. The use of CPX testing in the determination of prognosis in heart failure patients is included.

scholarly journals The value of cardiopulmonary exercise testing in individuals with apparently asymptomatic severe aortic stenosis: A pilot study

2014 ◽  
Vol 107 (10) ◽  
pp. 519-528 ◽  
Author(s):  
Franck Levy ◽  
Nader Fayad ◽  
Antoine Jeu ◽  
Dominique Choquet ◽  
Catherine Szymanski ◽  
...  
Keyword(s):  
Pilot Study ◽  
Aortic Stenosis ◽  
Exercise Testing ◽  
Severe Aortic Stenosis ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise

scholarly journals 53 Exercise oxygen kinetic in hypertrophic cardiomyopathy: results from a multicentre cardiopulmonary exercise testing study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Massimo Mapelli ◽  
Simona Romani ◽  
Damiano Magrì ◽  
Marco Merlo ◽  
Marco Cittar ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Hypertrophic Cardiomyopathy ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Pressure ◽  
Carbon Dioxide Production ◽  
Temporal Behaviour ◽  
Cardiopulmonary Exercise ◽  
O2 Pulse ◽  
Dynamic Relationships

Abstract Aims Reduced cardiac output (CO) has been considered crucial in symptoms’ genesis in hypertrophic cardiomyopathy (HCM). We evaluated the cardiopulmonary exercise testing (CPET) response in HCM focusing on parameters strongly associated with stroke volume (SV) and cardiac output (CO), such as oxygen uptake (VO2) and O2-pulse, considering both their absolute values and temporal behaviour during physical exercise. Methods and results We enrolled 312 non-end stage HCM patients, divided according to left ventricle outflow tract obstruction (LVOTO) at rest or during Valsalva manoeuver (72% with LVOTO &lt; 30; 10% between 30 and 49; and 18% ≥50 mmHg). Peak VO2 (percent of predicted), O2-pulse, and ventilation to carbon dioxide production (VE/VCO2) slope did not change across LVOTO groups. Ninety-six (31%) HCM patients presented an abnormal O2-pulse temporal behaviour, irrespective of LVOTO values. These patients showed lower peak systolic pressure, workload (106 ± 45 vs. 130 ± 49 W), VO2 (74 ± 17% vs. 80 ± 20%) and O2-pulse (12 [9–14] vs. 14 [11–17]ml/beat), with higher VE/VCO2 slope (28 [25–31] vs. 27 [24–31]) (P &lt; 0.005 for all). Only two patients had an abnormal VO2/work slope. Conclusions None of CPET parameters, either as absolute values or dynamic relationships, were associated with LVOTO. Differently, an abnormal O2-pulse exercise behaviour, which is strongly related to inadequate SV during exercise, correlates with reduced functional capacity (peak and anaerobic threshold VO2 and workload) and increased VE/VCO2 slope, helping identifying more advanced disease irrespectively of LVOTO. Adding O2-pulse kinetics evaluation to standard CPET could lead to a potential incremental benefit in terms of HCM prognostic stratification and, then, therapeutic management.

scholarly journals Summary Statement on Cardiopulmonary Exercise Testing in Chronic Heart Failure due to Left Ventricular Dysfunction Recommendations for Performance and Interpretation

2016 ◽  
Vol 68 (1) ◽  
Author(s):  
Ugo Corrà ◽  
Massimo F. Piepoli
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular Dysfunction ◽  
Exercise Testing ◽  
Ventricular Dysfunction ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Relevant Information ◽  
Left Ventricular ◽  
Cardiopulmonary Exercise

Cardiopulmonary exercise testing (CPET) is a non-invasive tool that provides the physician with relevant information to assess the integrated response to exercise involving pulmonary, cardiovascular, haematopoietic, neuro-psychological, and skeletal muscle systems. Measurement of expiratory gases during exercise allows the best estimate of functional capacity, grade the severity of the impairment, objectively evaluate the response to interventions, objectively track the progression of disease, and assist in differentiating cardiac from pulmonary limitations in exercise tolerance. To achieve optimal use of this test in every day clinical practice, clarification of conceptual issues and standardization of CPET practices are necessary. Recently, a Statement on Cardiopulmonary Exercise Testing in Chronic Heart Failure due to Left Ventricular Dysfunction, by the Gruppo Italiano di Cardiologia Riabilitativa and endorsed by the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology, has been published. Here are resumed the cardinal points of the Statement: (1) Definition of Cardiopulmonary Exercise Testing Parameters for Appropriate Use in Chronic Heart Failure, (2) How to Perform Cardiopulmonary Exercise Testing in Chronic Heart Failure, (3) Interpretation of Cardiopulmonary Exercise Testing in Chronic Heart Failure and Future Applications.

Approach to the Patient with Dyspnea

2016 ◽  
Author(s):  
Roza Badr Eslam ◽  
Aaron B Waxman
Keyword(s):  
Exercise Testing ◽  
Subjective Experience ◽  
Consensus Statement ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Flow Diagram ◽  
Cardiopulmonary Exercise ◽  
Patient Complaints ◽  
Common Causes ◽  
The Common

Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular disease. In a consensus statement, the American Thoracic Society defined dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Dyspnea is a nonspecific complaint and is one of the most frequent patient complaints. This review discusses the definition, epidemiology, etiology, pathophysiology, peripheral mechanisms, and evaluation of dyspnea. Figures depict cellular metabolism and exercise physiology, and an invasive cardiopulmonary exercise testing (iCPET) flow diagram. Tables list the common causes of dyspnea, invasive cardiopulmonary exercise testing (iCPET) diagnosis, and iCPET characteristics of pulmonary hypertension. This review contains 2 highly rendered figures, 3 tables, and 51 references.

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