The Safety of Cardiopulmonary Exercise Testing in a Population With High-Risk Cardiovascular Diseases

Abstract

Background-Cardiopulmonary exercise testing (CPX) with measurement of peak oxygen uptake (VO 2 ) is a powerful test for assessment and quantification of functional impairment resulting from cardiovascular disease. The safety of CPX has been established in patients with coronary artery disease and congestive heart failure, but clinical use of CPX in other cardiac diseases has been limited, in part because of a paucity of safety data. This study investigates the safety of CPX in a heterogeneous cohort of patients with a wide variety of underlying high-risk cardiac diagnoses. Methods and Results-This single-center retrospective review examined 5060 CPX studies performed in 4250 unique patients, including 1748 (35%) female subjects and 686 (14%) subjects aged Ն75 years. The primary end point was major adverse event during stress testing. The study population included patients with a variety of high-risk cardiac diseases, including congestive heart failure (nϭ1289, 25.5%), hypertrophic cardiomyopathy (nϭ598, 11.8%), pulmonary hypertension (nϭ194, 3.8%), and aortic stenosis (nϭ212, 4.2%). This patient population generally had severe functional impairment, including 1192 (24%) patients with peak VO 2 Ͻ14 mL/kg/min. Eight adverse events occurred during CPX, for an adverse event rate of 0.16%. The most common adverse event (nϭ6) was sustained ventricular tachycardia. There were no fatal events. Conclusions-CPX is generally a safe procedure, even in a population with underlying high-risk cardiovascular diagnoses. (Circulation. 2012;126:2465-2472.)

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

“…Safety Adverse events are rare during properly supervised tests (table 1). In the largest study looking at 5060 cardiopulmonary exercise tests in high-risk cardiovascular patients, including 196 PAH patients, the adverse event rate was 0.16% with no fatalities [27]. In a study of PAH in adults, there were no events in 242 tests [28].…”

A clinician's guide to cardiopulmonary exercise testing 1: an introduction

“…However from these central variables, a number of other prognostically important markers of cardiorespiratory function can also be derived (Table 1). Maximal exercise testing with integrated gas exchange is a safe procedure, even in populations with higher underlying risk diagnoses; including heart failure, hypertrophic cardiomyopathy, pulmonary hypertension, aortic stenosis, and chronic obstructive pulmonary disease (Skalski, Allison, & Miller, 2012). Reported rates of death for patients during maximal exercise testing are approximately 2 to 5 per 100,000 clinical exercise tests (Balady et al, 2010).…”

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

“…Multiple studies in adults [83,96,97] and children [89,98,99] have suggested that this is not a problem. In the largest study looking at CPET in high risk cardiovascular patients (n = 5060 CPET events) [97], adverse event rate was 0.16% with no fatalities. In a study dedicated to PAH [96], there were no events in 242 tests.…”