Cardiopulmonary Exercise Testing in the Functional and Prognostic Evaluation of Patients with Pulmonary Diseases

Ferrazza, Alessandro Maria; Martolini, Dario; Valli, Gabriele; Palange, Paolo

doi:10.1159/000186694

Cited by 166 publications

(182 citation statements)

References 203 publications

(156 reference statements)

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“…Fell et al 19 also retrospectively showed a threshold of 8.3 mL/kg/min in peak V O 2 to predict survival of 117 IPF subjects, 19 whereas Triantafillidou et al 15 prospectively demonstrated a threshold of 14.2 mL/kg/min for survival among 25 subjects with IPF. 15 Despite the fact that peak V O 2 has been shown as an accurate and reliable prognostic predictor in many cardiopulmonary diseases, [8][9][10] in Fell's study, 19 only 8 subjects (6.83%) were below the 8.3 mL/kg/min threshold, but about 46% died, which make this threshold much less sensitive. 19 Furthermore, a threshold of 14.2 mL/kg/min seems to have a good sensitivity in predicting mortality based on the report of Triantafillidou et al 15 However, their findings are limited by a small sample size and so cannot be generalized, as well as contradicting previous reports.…”

Section: Discussionmentioning

confidence: 98%

“…8,9,12,33 Subjects were instructed to take their usual medications as prescribed. All tests were conducted between 8:30 a.m. and 12:30 p.m. to maximal subjective exertion level and respiratory exchange ratio (Ն1.1) and were supervised by a physician.…”

Section: Cpetmentioning

confidence: 99%

“…Based on previously established prognostic CPET data in heart and lung disease [8][9][10][11][12][13] as well as in patients with IPF, 14,15,19,20 the primary outcomes of the current study were peak V O 2 , peak work rate, V E /V O 2 nadir, anaerobic threshold V E /V CO 2 , and tidal volume reserve cut-off points using CPET in subjects with IPF. The secondary outcome was characterizing non-survivor subjects with IPF.…”

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

“…3 Cardiopulmonary exercise testing (CPET) is a reliable, accurate, and valid tool and is considered the accepted standard measurement for cardio-respiratory capacity (peak V O 2 ) and exercise limitations. [8][9][10][11][12][13] Peak V O 2 is a well-established universal prognostic parameter that represents the physiological capacity of the heart, lungs, and skeletal muscles to supply aerobically the metabolic demand for the body's physical functioning. 11,12 In the past few decades, ventilatory efficiency parameters, such as the ratio of ventilation to carbon dioxide slope and the ratio of ventilation to carbon dioxide at the anaerobic threshold (V E /V CO 2 at the anaerobic threshold) have also showed strong prognostic value in many chronic conditions, including IPF.…”

Section: Introductionmentioning

confidence: 99%

“…[16][17][18] CPET has some ameliorated prognostic value compared with resting cardiopulmonary functions both in cardiac and lung disease patients. [8][9][10][11][12][13] A few studies have shown several CPET parameters as prognostic predictors in subjects with IPF as well. 14,15,19,20 However, these studies have significant limitations in terms of retrospective methodology, 14 low sensitivity level, 19 and challenging implementation in clinical practice, due to complicity and lack of availability.…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

et al. 2016

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BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal interstitial lung disease associated with poor prognosis and limited effective treatment options. Reliable predictors of outcome in daily clinical practice are needed to determine high-risk patients for urgent lung transplantation referral. This study aimed to identify practical prognostic predictors of mortality using cardiopulmonary exercise testing (CPET) in IPF subjects. METHODS: Thirty-four subjects with IPF (22 men and 12 women), median age 68 (range 50 -81) y were prospectively studied. At baseline, all subjects were assessed with CPET and were followed up for 40 months from baseline. Receiver operating characteristic curve analysis was conducted to determine cut-off points of CPET variables for mortality, Cox regression analysis for survival using a log-rank test, and hazard ratio for death using a Wald test. RESULTS: Peak work rate <62 watts (P ‫؍‬ .005), peak V O 2 <13.8 mL/kg/min (P ‫؍‬ .031), tidal volume reserve <0.48 L/breath (P ‫؍‬ .010), minute ventilation to carbon dioxide (V E )/V CO 2 ) ratio at the anaerobic threshold >34 (P ‫؍‬ .02), and V E )/V O 2 nadir >34 (P ‫؍‬ .002) were detected as cut-off points associated with mortality. Non-survivor subjects were characterized by higher dyspnea levels, the presence of pulmonary hypertension assessed by echocardiography, pronounced inefficient ventilatory pattern, lower exercise capacity, and more severe desaturation during physical exertion. By the end of the study, 11 subjects (7 women and 4 men) died. Overall mean survival was 60%, 33.7 months (95% CI 30.2-37.2). CONCLUSIONS: This study provides simple, practical, and novel cut-off points for CPET as predictors of prognosis to identify high-risk IPF subjects. Impairment in exercise capacity and abnormal ventilatory responses during CPET were associated with poorer survival in IPF subjects. The findings suggest considering the use of CPET for IPF risk stratification and prediction of prognosis. (ClinicalTrials.gov registration NCT01499745.) Key words: cardiopulmonary exercise testing, survival, prognostic predictors, ventilatory response, exercise intolerance. [Respir Care 2016;61(8):1100 -1109.

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Section: Discussionmentioning

confidence: 98%

Section: Cpetmentioning

confidence: 99%

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

et al. 2016

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Exercise tolerance, lung function abnormalities, anemia, and cardiothoracic ratio in sickle cell patients

et al. 2014

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Many patients with sickle cell disease (SCD) have a reduced exercise capacity and abnormal lung function. Cardiopulmonary exercise testing (CPET) can identify causes of exercise limitation. Forty-four consecutive SCD patients (27 HbSS, 11 HbSC, and 6 HbS-beta thalassemia) with a median age (interquartile range) of 26 (21-41) years underwent pulmonary function tests, CPET, chest x-ray, and echocardiography to further characterize exercise limitation in SCD. Peak oxygen uptake (V 0 O 2 -peak), expressing maximum exercise capacity, was decreased in 83% of the studied patients. V 0 O 2 -peak correlated with hemoglobin levels (R 5 0.440, P 5 0.005), forced vital capacity (FVC) (R 5 0.717, P < 0.0001). Cardiothoracic ratio on chest x-ray inversely correlated with FVC (R 5 20.637, P < 0.001). According to criteria for exercise limitation, the patients were limited in exercise capacity due to anemia (n 5 17), cardiovascular dysfunction (n 5 2), musculoskeletal function (n 5 10), pulmonary ventilatory abnormalities (n 5 1), pulmonary vascular exercise limitation (n 5 1), and poor effort (n 5 3). In the present study we demonstrate that anemia is the most important determinant of reduced exercise tolerance observed in SCD patients without signs of pulmonary hypertension. We found a strong correlation between various parameters of lung volume and cardiothoracic ratio and we hypothesize that cardiomegaly and relative small chest size may be important causes of the impairment in pulmonary function, that is, reduced long volumes and diffusion capacity, in SCD. Taking into account anthropomorphic differences between SCD patients and controls could help to interpret lung function studies in SCD better.

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Factors Limiting Exercise Tolerance in Chronic Lung Diseases

Vogiatzis

Zakynthinos

2012

Comprehensive Physiology

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The major limitation to exercise performance in patients with chronic lung diseases is an issue of great importance since identifying the factors that prevent these patients from carrying out activities of daily living provides an important perspective for the choice of the appropriate therapeutic strategy. The factors that limit exercise capacity may be different in patients with different disease entities (i.e., chronic obstructive, restrictive or pulmonary vascular lung disease) or disease severity and ultimately depend on the degree of malfunction or miss coordination between the different physiological systems (i.e., respiratory, cardiovascular and peripheral muscles). This review focuses on patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and pulmonary vascular disease (PVD). ILD and PVD are included because there is sufficient experimental evidence for the factors that limit exercise capacity and because these disorders are representative of restrictive and pulmonary vascular disorders, respectively. A great deal of emphasis is given, however, to causes of exercise intolerance in COPD mainly because of the plethora of research findings that have been published in this area and also because exercise intolerance in COPD has been used as a model for understanding the interactions of different pathophysiologic mechanisms in exercise limitation. As exercise intolerance in COPD is recognized as being multifactorial, the impacts of the following factors on patients' exercise capacity are explored from an integrative physiological perspective: (i) imbalance between the ventilatory capacity and requirement; (ii) imbalance between energy demands and supplies to working respiratory and peripheral muscles; and (iii) peripheral muscle intrinsic dysfunction/weakness.

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Cardiopulmonary Exercise Testing in the Functional and Prognostic Evaluation of Patients with Pulmonary Diseases

Cited by 166 publications

References 203 publications

The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

Exercise tolerance, lung function abnormalities, anemia, and cardiothoracic ratio in sickle cell patients

Factors Limiting Exercise Tolerance in Chronic Lung Diseases

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