Cardiopulmonary exercise testing in the assessment of exertional dyspnea

Debapriya Datta, Edward Normandin, Richard ZuWallack, Debapriya Datta, Edward Normandin, Richard ZuWallack

Abstract

Dyspnea on exertion is a commonly encountered problem in clinical practice. It is usually investigated by resting tests such as pulmonary function tests and echocardiogram, which may at times can be non-diagnostic. Cardiopulmonary exercise testing (CPET) measures physiologic parameters during exercise which can enable accurate identification of the cause of dyspnea. Though CPET has been around for decades and provides valuable and pertinent physiologic information on the integrated cardiopulmonary responses to exercise, it remains underutilized. The objective of this review is to provide a comprehensible overview of the underlying principles of exercise physiology, indications and contraindications of CPET, methodology and interpretative strategies involved and thereby increase the understanding of the insights that can be gained from the use of CPET.

Keywords: Anaerobic threshold; carbon dioxide output; cardiopulmonary exercise test; dyspnea; exercise limitation; oxygen uptake.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Physiologic response to exercise
Figure 2
Figure 2
Cell bioenergetics during exercise
Figure 3
Figure 3
Changes in physiological parameters with exercise (From Weisman: Clinics in Chest Medicine 2001, with permission.)
Figure 4
Figure 4
The V-slope method of determining Anaerobic Threshold (AT)
Figure 5
Figure 5
Automated system for CPET
Figure 6
Figure 6
Graphic display of response to exercise in a normal subject on cardiopulmonary exercise testing
Figure 7
Figure 7
Graphic display of response to exercise in patient with lung disease on cardiopulmonary exercise testing (ventilatory limitation to exercise)
Figure 8
Figure 8
Graphic display of response to exercise in patient with heart disease on cardiopulmonary exercise testing (cardiac limitation to exercise)
Figure 9
Figure 9
Graphic display of response to exercise in a patient with pulmonary hypertension on cardiopulmonary exercise testing (gas exchange limitation to exercise)

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