Cardiopulmonary exercise testing

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Cardiopulmonary exercise testing
A patient during cardiopulmonary exercise testing.
(Image courtesy of Dr Paul Older)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Cardiopulmonary exercise testing (CPET) is a relatively noninvasive method of testing that measures respiratory gas exchange (e.g., oxygen uptake (VO2), carbon dioxide output (VCO2), minute ventilation (VE), and anaerobic threshold), in addition to monitoring electrocardiography, blood pressure, and pulse oximetry during a maximal progressive exercise tolerance test. [1] [2] [3]

When appropriate, arterial sampling is also performed to provide more detailed information about pulmonary gas exchange.

Performing this test may required in following situations: [4] [5]

  • Assistance in the differentiation of cardiac versus pulmonary limitations as a cause of exercise-induced dyspnea or impaired exercise capacity when the cause is uncertain
  • Identification of high-risk patients presenting with heart failure who are candidates for cardiac transplantation or other advanced treatment
  • Evaluation of exercise capacity when indicated for medical reasons in patients with cardiac pathology for whom the estimates of exercise capacity from exercise test time or work rate are unreliable
  • Evaluation of patients presenting with heart failure to help determine whether heart failure is the cause of exercise limitations when the contribution of heart failure is uncertain
  • Adjunct to preoperative assessment for patients being considered for lung cancer resectional surgery, when cardiovascular evaluation or pulmonary function testing indicates patient is at increased risk for perioperative complications.

References

  1. Hunt SA. 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). 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). J Am Coll Cardiol. 2005 Sep 20;46(6):e1-82.
  2. Erratum in: J Am Coll Cardiol. 2006 Apr 7;47(7):1503-1505 for Hunt SA. 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). 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). J Am Coll Cardiol. 2005 Sep 20;46(6):e1-82.
  3. Task force of the Italian Working Group on Cardiac Rehabilitation Prevention: Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. Piepoli MF, Corra U, Agostoni PG, Bellardinelli R, Cohen-Solal A, Hembrecht R, Vanhees L. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part I: definition of cardiopulmonary exercise testing parameters for appropriate use in chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2006 Apr;13(2):150-64.
  4. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: a report of the 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 Oct 16;40(8):1531-40. Erratum in: J Am Coll Cardiol. 2006 Oct 17;48(8):1731
  5. Erratum in: J Am Coll Cardiol. 2006 Oct 17;48(8):1731 for Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: a report of the 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 Oct 16;40(8):1531-40.

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