Cardiopulmonary Exercise Testing in Sports Cardiology

2019 ◽  
Vol 67 (1) ◽  
Keyword(s):  
Exercise Testing ◽  
Leisure Time ◽  
Elite Athletes ◽  
Cardiopulmonary Exercise Testing ◽  
Medical Advice ◽  
Sports Cardiology ◽  
Exertional Dyspnea ◽  
Cardiopulmonary Exercise ◽  
Work Up ◽  
Rule Out

Leisure-time and elite athletes often seek sports medical advice for inadequate exertional dyspnea and loss of performance. The work-up has to rule-out underlying cardiac pathologies that are associated with sudden cardiac death, although commonly the symptoms are training- and not disease-related. Cardiopulmonary exercise testing (CPET) helps to differentiate between cardiac and pulmonary causes and guides further diagnostic and therapy. This article illustrates the potential of CPET in three clinical cases.

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.

scholarly journals Clinical Interpretation of Cardiopulmonary Exercise Testing: Current Pitfalls and Limitations

2021 ◽  
Vol 12 ◽  
Author(s):  
J. Alberto Neder ◽  
Devin B. Phillips ◽  
Mathieu Marillier ◽  
Anne-Catherine Bernard ◽  
Danilo C. Berton ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Work Of Breathing ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Exertional Dyspnea ◽  
Non Invasive ◽  
Cardiopulmonary Exercise ◽  
Direct Measurements ◽  
Severe Impairment ◽  
End Tidal

Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O2) despite a low peak WR. Among the determinants of V̇O2, only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O2delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that “the lungs” are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased “wasted” ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO2might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician.

scholarly journals Unexplained Exertional Dyspnea Caused by Low Ventricular Filling Pressures: Results from Clinical Invasive Cardiopulmonary Exercise Testing

2016 ◽  
Vol 6 (1) ◽  
pp. 55-62 ◽  
Author(s):  
William M. Oldham ◽  
Gregory D. Lewis ◽  
Alexander R. Opotowsky ◽  
Aaron B. Waxman ◽  
David M. Systrom
Keyword(s):  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exertional Dyspnea ◽  
Cardiopulmonary Exercise ◽  
Ventricular Filling

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.

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