Cardiopulmonary exercise testing – refining the clinical perspective by combining assessments

ABSTRACT

Introduction

Cardiorespiratory fitness (CRF) is now established as a vital sign. Cardiopulmonary exercise testing (CPX) is the gold-standard approach to assessing CRF.

Areas covered

A body of literature spanning several decades clearly supports the clinical utility of CPX in those who are apparently health and at risk for chronic disease as well as numerous patient populations. While CPX, in and of itself, is a valid and reliable clinical assessment, combining findings with other available assessments may provide a more comprehensive perspective that enhances clinical decision making and outcomes. The current review will accomplish the following: (1) define key CPX measures based upon current evidence; and (2) describe the current evidence addressing the relationships between CPX and echocardiography, serum biomarkers, and cardiovascular magnetic resonance.

Expert opinion

Cardiopulmonary exercise testing provides prognostic and diagnostic information in apparently healthy individuals, those at risk for one or more chronic conditions, as well as numerous patient populations. Moreover, if the goal of an intervention is to improve one or more systems integral to the physiologic response to exercise, CPX should be considered as a central assessment to gauge therapeutic efficacy. To further refine the information obtained from CPX, combining other assessments has demonstrated promise.

KEYWORDS:

• Exercise testing
• oxygen consumption
• ventilatory efficiency
• cardiovascular imaging
• biomarkers
• echocardiography
• magnetic resonance

Article highlights

• Cardiorespiratory fitness is now considered a vital sign

• Cardiopulmonary exercise testing is the gold-standard assessment for cardiorespiratory fitness

• Cardiopulmonary exercise testing provides the opportunity to quantify a number of relevant measures; assessing these measures in combination is preferred over assessment of any one measure in isolation

• Exercise capacity, measured as peak or maximal oxygen consumption, and ventilatory efficiency, measured as the minute ventilation/carbon dioxide production slope, are the two most studied and assessed measures obtained through cardiopulmonary exercise testing

• The use of cardiopulmonary exercise testing is most common in patients with suspected or confirmed cardiopulmonary disease, such as heart failure or pulmonary hypertension

• Evidence continues to emerge demonstrating the value of combining cardiopulmonary exercise testing with other assessments, such as echocardiography, serum biomarkers or cardiac magnetic resonance. Presently, evidence indicates combining cardiopulmonary exercise testing with other assessments can provide additional insight into the physiologic response to physical exertion, the type and degree of pathophysiology present, and treatment efficacy in clinical trials

• Additional research is needed to clarify the value of combining cardiopulmonary exercise testing with other assessments in order to establish clinical practice guidelines and standardize procedures for clinical trials when an exercise assessment is utilized.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.