619
Views
78
CrossRef citations to date
0
Altmetric
Clinical Focus Drug Resistance, Renal Disease, and Hypertension

Cardiopulmonary Exercise Testing: Relevant but Underused

, MD, , PhD, , MD, , MD, PhD, & , PhD
Pages 68-86 | Published online: 13 Mar 2015

References

  • . Richardson RS, Harms CA, Grassi B, Hepple RT. Skeletal muscle: master or slave of the cardiovascular system? Med Sci Sports Exerc. 2000;32(1):89–93
  • . Duscha BD, Schulze PC, Robbins JL, Forman DE. Implications of chronic heart failure on peripheral vasculature and skeletal muscle before and after exercise training. Heart Fail Rev. 2008;13(1):21–37
  • . Jones NL, Killian KJ. Exercise limitation in health and disease. N Engl J Med. 2000;343(9):632–641
  • . Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801
  • . Kodama S, Saito K, Tanaka S, . Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–2035
  • . Arena R, Myers J, Williams MA, ; American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Nursing. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007;116(3):329–343
  • . Balady GJ, Arena R, Sietsema K, ; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; and Interdisciplinary Council on Quality of Care and Outcomes Research. Clinician's guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(2):191–225
  • . Savage PD, Toth MJ, Ades PA. A re-examination of the metabolic equivalent concept in individuals with coronary heart disease. J Cardiopulm Rehabil Prev. 2007;27(3):143–148
  • . Myers J, Buchanan N, Walsh D, . Comparison of the ramp versus standard exercise protocols. J Am Coll Cardiol. 1991;17(6):1334–1342
  • . Lavie CJ, Milani RV. Metabolic equivalent (MET) inflation—not the MET we used to know. J Cardiopulm Rehabil Prev. 2007;27(3):149–150
  • . Crouter SE, Antczak A, Hudak JR, Della-Valle DM, Haas JD. Accuracy and reliability of the ParvoMedics TrueOne 2400 and MedGraphics VO2000 metabolic systems. Eur J Appl Physiol. 2006;98(2):139–151
  • . Bergh U, Kanstrup IL, Ekblom B. Maximal oxygen uptake during exercise with various combinations of arm and leg work. J Appl Physiol. 1976;41(2):191–196
  • . Clark AL. Origin of symptoms in chronic heart failure. Heart. 2006;92(1):12–16
  • . Hunt SA, Abraham WT, Chin MH, . ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112(12):e154–e235
  • . Witte KK, Clark AL. Why does chronic heart failure cause breathlessness and fatigue? Prog Cardiovasc Dis. 2007;49(5):366–384
  • . Gibbons RJ, Balady GJ, Bricker JT, ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee to Update the 1997 Exercise Testing Guidelines. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002;40(8):1531–1540
  • . American Thoracic Society American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–277
  • . Myers J, Arena R, Franklin B, ; American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention of the Council on Clinical Cardiology, the Council on Nutrition, Physical Activity, and Metabolism, and the Council on Cardiovascular Nursing. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation. 2009;119(24):3144–3161
  • . Maeder MT, Wolber T, Ammann P, . Cardiopulmonary exercise testing in mild heart failure: impact of the mode of exercise on established prognostic predictors. Cardiology. 2008;110(2):135–141
  • . Lockwood PA, Yoder JE, Deuster PA. Comparison and cross-validation of cycle ergometry estimates of VO2max. Med Sci Sports Exerc. 1997;29(11):1513–1520
  • . Miyamura M, Honda Y. Oxygen intake and cardiac output during maximal treadmill and bicycle exercise. J Appl Physiol. 1972;32(2):185–188
  • . Balady GJ, Weiner DA, McCabe CH, Ryan TJ. Value of arm exercise testing in detecting coronary artery disease. Am J Cardiol. 1985;55(1):37–39
  • . Wasserman K, Hansen JE, Sue DY, . Normal Values. In: Weinberg R, ed. Principles of Exercise Testing and Interpretation. Philadelphia, PA: Lippincott, Williams and Wilkins, 2005:160–182
  • . Hlatky MA, Boineau RE, Higginbotham MB, . A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989;64(10):651–654
  • . Myers J, Bader D, Madhavan R, Froelicher V. Validation of a specific activity questionnaire to estimate exercise tolerance in patients referred for exercise testing. Am Heart J. 2001;142(6):1041–1046
  • . Osman AF, Mehra MR, Lavie CJ, . The incremental prognostic importance of body fat adjusted peak oxygen consumption in chronic heart failure. J Am Coll Cardiol. 2000;36(7):2126–2131
  • . Kim ES, Ishwaran H, Blackstone E, Lauer MS. External prognostic validations and comparison age- and gender-adjusted exercise capacity predictions. J Am Coll Cardiol. 2007;50(19):1867–1875
  • . Arena R, Myers J, Abella J, . Determining the preferred percent-predicted equation for peak oxygen consumption in patients with heart failure. Circ Heart Fail. 2009;2(2):113–120
  • . Mezzani A, Corrà U, Bosimini E, Giordano A, Giannuzzi P. Contribution of peak respiratory exchange ratio to peak VO2 prognostic reliability in patients with chronic heart failure and severely reduced exercise capacity. Am Heart J. 2003;145(6):1102–1107
  • . Wackers FJ. Customized exercise testing. J Am Coll Cardiol. 2009;54(6):546–548
  • . Myers J. Principles of exercise prescription for patients with chronic heart failure. Heart Fail Rev. 2008;13(1):61–68
  • . American College of Sports Medicine. ACSM's Guidelines For Exercise Testing and Prescription. 8th ed. Baltimore, MD: Lippincott, Williams and Wilkins; 2009
  • . Strzelczyk TA, Quigg RJ, Pfeifer PB, Parker MA, Greenland P. Accuracy of estimating exercise prescription intensity in patients with left ventricular systolic dysfunction. J Cardiopulm Rehabil. 2001;21(3):158–163
  • . Myers J, Goldsmith RL, Keteyian SJ, . The ventilatory anaerobic threshold in heart failure: a multicenter evaluation of reliability. J Card Fail. 2010;16(1):76–83
  • . Belardinelli R, Lacalaprice F, Carle F, . Exercise-induced myocardial ischemia detected by cardiopulmonary exercise testing. Eur Heart J. 2003;24(4):1304–1313
  • . Oliveira RB, Myers J, Araújo CG, Abella J, Mandic S, Froelicher V. Maximal exercise oxygen pulse as a predictor of mortality among male veterans referred for exercise testing. Eur J Cardiovasc Prev Rehabil. 2009;16(3):358–364
  • . Lavie CJ, Milani RV, Mehra MR. Peak exercise oxygen pulse and prognosis in chronic heart failure. Am J Cardiol. 2004;93(5):588–593
  • . Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail Rev. 2008;13(2):245–269
  • . Holverda S, Bogaard HJ, Groepenhoff H, Postmus PE, Boonstra A, Vonk-Noordegraaf A. Cardiopulmonary exercise test characteristics in patients with chronic obstructive pulmonary disease and associated pulmonary hypertension. Respiration. 2008;76(2):160–167
  • . Arena R, Myers J, Abella J, . Development of a ventilatory classification system in patients with heart failure. Circulation. 2007;115(18):2410–2417
  • . Wada O, Asanoi H, Miyagi K, . Importance of abnormal lung perfusion in excessive exercise ventilation in chronic heart failure. Am Heart J. 1993;125(3):790–798
  • . Ponikowski P, Francis DP, Piepoli MF, . Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation. 2001;103(7):967–972
  • . Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation. 2001;104(4):429–435
  • . Bradley TD. The ups and downs of periodic breathing: implications for mortality in heart failure. J Am Coll Cardiol. 2003;41(12):2182–2184
  • . Leite JJ, Mansur AJ, de Freitas HF, . Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation. J Am Coll Cardiol. 2003;41(12):2175–2181
  • . Guazzi M, Arena R, Ascione A, ; Gruppo di Studio Fisiologia dell'Esercizio, Cardiologia dello Sport e Riabilitazione Cardiovascolare of the Italian Society of Cardiology. Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value. Am Heart J. 2007;153(5):859–867
  • . Ingle L, Isted A, Witte KK, Cleland JG, Clark A. Impact of different diagnostic criteria on the prevalence and prognostic significance of exertional oscillatory ventilation in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2009;16(4):451–456
  • . Guazzi M, Myers J, Peberdy MA, . Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights. Eur Heart J. 2008;29(22):2751–2759
  • . Ponikowski P, Anker SD, Chua TP, . Oscillatory breathing patterns during wakefulness in patients with chronic heart failure: clinical implications and role of augmented peripheral chemosensitivity. Circulation. 1999;100(24):2418–2424
  • . Corra U, Giordano A, Bosimini E, . Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest. 2002;121(5):1572–1580
  • . Sun XG, Hansen JE, Beshai JF, Wasserman K. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early morbidity and mortality in heart failure. J Am Coll Cardiol. 2010;55(17):1814–1823
  • . Matsumoto A, Itoh H, MD, Eto Y, . End-tidal CO2 pressure decreases during exercise in cardiac patients: association with severity of heart failure and cardiac output reserve. J Am Coll Cardiol. 2000;36(1):242–249
  • . Jin X, Weil MH, Tang W, . End-tidal carbon dioxide as a noninvasive indicator of cardiac index during circulatory shock. Crit Care Med. 2000;28(7):2415–2419
  • . Isserles SA, Breen PH. Can changes in end-tidal PCO2 measure changes in cardiac output? Anesth Analg. 1991;73(6):808–814
  • . Arena R, Guazzi M, Myers J. Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure. Int J Cardiol. 2007;117(1):103–108
  • . Arena R, Myers J, Abella J, . The partial pressure of resting end-tidal carbon dioxide predicts major cardiac events in patients with systolic heart failure. Am Heart J. 2008;156(5):982–988
  • . Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. ERS Task Force on Standardization of Clinical Exercise Testing. European Respiratory Society. Eur Respir J. 1997;10(11):2662–2689
  • . Miller MR, Hankinson J, Brusasco V, . Standardisation of spirometry. Eur Respir J. 2005;26(2):319–338
  • . Johnson BD, Weisman IM, Zeballos RJ, Beck KC. Emerging concepts in the evaluation of ventilatory limitation during exercise: the exercise tidal flow-volume loop. Chest. 1999;116(2):488–503
  • . Bjurö T, Gullestad L, Endresen K, . Evaluation of ST-segment changes during and after maximal exercise tests in one-, two- and three-vessel coronary artery disease. Scand Cardiovasc J. 2004;38(5):270–277
  • . Pitsavos CH, Chrysohoou C, Panagiotakos DB, . Exercise capacity and heart rate recovery as predictors of coronary heart disease events, in patients with heterozygous familial hypercholesterolemia. Atherosclerosis. 2004;173(2):347–350
  • . Freeman JV, Dewey FE, Hadley DM, Myers J, Froelicher VF. Autonomic nervous system interaction with the cardiovascular system during exercise. Prog Cardiovas Dis. 2006;48(5):342–362
  • . Jouven X, Empana JP, Schwartz PJ, Desnos M, Courbon D, Ducimetière P. Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med. 2005;352(19):1951–1958
  • . Myers J, Arena R, Dewey F, . A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure. Am Heart J. 2008;156(6):1177–1183
  • . Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol. 2003;42(5):831–838
  • . Lauer M, Froelicher ES, Williams M, Kligfield P; American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Exercise testing in asymptomatic adults: a statement for professionals from the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2005;112(5):771–776
  • . Arena R, Guazzi M, Myers J, . Prognostic value of heart rate recovery in patients with heart failure. Am Heart J. 2006;151(4):e7–e13
  • . Shetler K, Marcus R, Froelicher VF, . Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol. 2001;38(7):1980–1987
  • . Lauer MS, Okin PM, Larson MG, Evans JC, Levy D. Impaired heart rate response to graded exercise: prognostic implications of chronotropic incompetence in the Framingham Heart Study. Circulation. 1996;93(8):1520–1526
  • . Gwinn N, Leman R, Kratz J, . Chronotropic incompetence: a common and progressive finding in pacemaker patients. Am Heart J. 1992;123(5):1216–1219
  • . Wilkoff BL, Corey J, Blackburn G. A mathematical model of the exercise cardiac chronotropic response to exercise. J Electrophysiol. 1989;3:176–180
  • . Khan MN, Pothier CE, Lauer MS. Chronotropic incompetence as a predictor of death among patients with normal electrocardiograms taking beta blockers. Am J Cardiol. 2005;96(9):1328–1333
  • . Abidov A, Rozanski A, Hachamovitch R, . Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med. 2005;353(18):1889–1898
  • . Borg G, Dahlstrom H. The reliability and validity of a physical work test. Acta Physiol Scand. 1962;55:353–361
  • . Mahler DA, Horowitz MB. Clinical evaluation of exertional dyspnea. Clin Chest Med. 1994;15(2):259–269
  • . Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289(2):194–202
  • . Brubaker PH, Marburger CT, Morgan TM, Fray B, Kitzman DW. Exercise responses of elderly patients with diastolic versus systolic heart failure. Med Sci Sports Exerc. 2003;35(9):1477–1485
  • . Farr MJ, Lang CC, Lamanca JJ, . Cardiopulmonary exercise variables in diastolic versus systolic heart failure. Am J Cardiol. 2008;102(2):203–206
  • . Witte KK, Nikitin NP, Cleland JG, Clark AL. Excessive breathlessness in patients with diastolic heart failure. Heart. 2006;92(10):1425–1429
  • . Guazzi M, Marenzi G, Assanelli E, . Evaluation of the dead space/tidal volume ratio in patients with chronic congestive heart failure. J Card Fail. 1995;1(5):401–408
  • . Wasserman K, Zhang YY, Gitt A, . Lung function and exercise gas exchange in chronic heart failure. Circulation. 1997;96(7):2221–2227
  • . O'Donnell DE, Banzett RB, Carrieri-Kohlman V, . Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable. Proc Am Thorac Soc. 2007;4(2):145–168
  • . Francis N, Cohen-Solal A, Logeart D. Peripheral muscle ergoreceptors and ventilatory response during exercise recovery in heart failure. Am J Physiol. 1999;276(3 pt 2):H913–H917
  • . Barr RG, Bluemke DA, Ahmed FS, . Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med. 2010;362(3):217–227
  • . Watz H, Waschki B, Meyer T, . Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation. Chest. 2010;138(1):32–38
  • . Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant. 2010;29(2):159–173
  • . Torchio R, Guglielmo M, Giardino R, . Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2010;38(1):14–19
  • . Killian KJ, Leblanc P, Martin DH, . Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. Am Rev Respir Dis. 1992;146(4):935–940
  • . Miki K, Maekura R, Hiraga T, . Impairment and prognostic factors for survival in patients with idiopathic pulmonary fibrosis (abstract). Resp Med. 2003;97(5):482–490
  • . Yasunobu Y, Oudiz RJ, Sun XG, Hansen JE, Wasserman K. End-tidal PCO2 abnormality and exercise limitation in patients with primary pulmonary hypertension. Chest. 2005;127(5):1637–1646
  • . Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension. Circulation. 2002;105(1):54–60
  • . Crapo RO, Casaburi R, Coates AL, . Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000;161(1):309–329
  • . Flaherty KR, Wald J, Weisman IM, . Unexplained exertional limitation: characterization of patients with a mitochondrial myopathy. Am J Respir Crit Care Med. 2001;164(3):425–432
  • . Siciliano G, Volpi L, Piazza S, Ricci G, Mancuso M, Murri L. Functional diagnostics in mitochondrial diseases. Biosci Rep. 2007;27(1–3):53–67
  • . Taivassalo T, Jensen TD, Kennaway N, DiMauro S, Vissing J, Haller RG. The spectrum of exercise tolerance in mitochondrial myopathies: a study of 40 patients. Brain. 2003;126(pt 2):413–423
  • . Lang CC, Karlin P, Haythe J, Tsao L, Mancini DM. Ease of noninvasive measurement of cardiac output coupled with peak VO2 determination at rest and during exercise in patients with heart failure. Am J Cardiol. 2007;99(3):404–405
  • . Medical Section of the American Lung Association. Guidelines for the evaluation of impairment/disability in patients with asthma. American Thoracic Society. Am Rev Respir Dis. 1993;147(4):1056–1061

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.