Cardiopulmonary Exercise Testing (CPET) In Adults

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed, Lucinda hampton and Kim Jackson

Introduction

Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrative exercise responses involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system function. This relatively noninvasive, dynamic physiologic overview permits the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision making. Once the exclusive province of research physiologists and specialized centers, CPET is increasingly being used in a wide spectrum of clinical applications for the evaluation of undiagnosed exercise intolerance and exercise-related symptoms, and for the objective determination of functional capacity and impairment. The use of CPET in patient management is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status correlates better with exercise tolerance rather than with resting measurements.

Cardiopulmonary exercise testing (CPET) is an examination that allows the investigator to simultaneously study the responses of the cardiovascular and ventilatory systems to a known exercise stress.This is possible because gas exchange at the airway is a consequence of cardiac output and pulmonary blood flow, as well as peripheral O2 extraction coupled to ventilation. Thus, the heart, with the circulation, couples gas exchanges (O2 and CO2) of muscle respiration with that at the lungs. The adequacy of the cardiovascular transport of O2 for known exercise work rates is described by the lung gas exchange.

CPET involves mainly the analysis of respiratory gases including.

• Respiratory oxygen uptake (Vo2),
• Carbon dioxide production (Vco2),
• Ventilatory measures during a symptom‐limited exercise test.

Purpose

• Diagnostic and prognostic evaluation of the cardiovascular and pulmonary diseases.
• Evaluation of the disease severity and functional effects.
• Assessment for suitability of treatment, i.e. surgery, transplantation, supplemental oxygen therapy
• Evaluation of efficacy of therapeutic intervention
• Outcome variable for clinical trials
• Measurable goals to improve fitness
• To measure of exercise rehabilitative training intensity
• Development of knowledge and understanding of the disease.

Technique

Cardiopulmonary exercise testing (CPET) can be assessed by Laboratory method

• Treadmill
• Bicycle ergometer

Indication

1. Evaluation of Exercise Intolerance
2. Unexplained Dyspnea
3. Evaluation of Patients with Cardiovascular Disease
4. Evaluation of Patients with Respiratory Disease 216
   • Chronic Obstructive Pulmonary Disease (COPD)
   • Interstitial Lung Disease (ILD)
   • Chronic Pulmonary Vascular Disease (PVD)
   • Cystic Fibrosis
   • Exercise Induced Broncospasm (EIB)
5. Preoperative Evaluation 216
   • Preoperative Evaluation for Lung Cancer Resectional Surgery
   • Lung Volume Reduction Surgery (LVRS)
   • Evaluation for Lung or Heart-Lung Transplantation
   • Preoperative Evaluation of Other Procedures
6. Exercise Prescription for Pulmonary Rehabilitation
7. Evaluation of Impairment/Disability

Contraindication

Absolute	Relative
Acute myocardial infarction (3–5 days)	Left main coronary stenosis or its equivalent
Unstable angina	Moderate stenotic valvular heart disease
Uncontrolled arrhythmias causing symptoms	Severe untreated arterial hypertension at rest
or hemodynamic compromise	(> 200 mm Hg systolic, > 120 mm Hg diastolic)
Syncope	Tachyarrhythmias or bradyarrhythmias
Active endocarditis	High-degree atrioventricular block
Acute myocarditis or pericarditis	Hypertrophic cardiomyopathy
Symptomatic severe aortic stenosis	Significant pulmonary hypertension
Uncontrolled heart failure	Advanced or complicated pregnancy
Acute pulmonary embolus or pulmonary infarction	Electrolyte abnormalities
Thrombosis of lower extremities	Orthopedic impairment that compromises exercise performance
Suspected dissecting aneurysm
Uncontrolled asthma
Pulmonary edema
Room air desaturation at rest ⩽ 85%[null *]
Respiratory failure
Acute noncardiopulmonary disorder that may affect
exercise performance or be aggravated by exercise   (i.e. infection, renal failure, thyrotoxicosis)
Mental impairment leading to inability to cooperate

References