The Value of Cardiopulmonary Exercise Testing in Predicting the Severity of Coronary Artery Disease

Abstract

Background: There have been a limited number of quantitative studies on the relationship between coronary artery disease (CAD) and cardiorespiratory fitness (CRF), as measured by cardiopulmonary exercise testing (CPET). Thus, we aimed to investigate the association between CRF and the severity of coronary artery disease from the most comprehensive perspective possible, and to affirm the predictive value of CPET in the severity assessment of CAD. Methods: Our study included 280 patients with coronary angiography, who had undergone CPET in Tongji Hospital. The patients’ CRF was measured through their peak oxygen uptake (VO2@peak), their oxygen uptake at the anaerobic threshold (VO2@AT) and through other parameters of CPET on a bicycle ergometer. The severity of the coronary artery disease was assessed in the following three layers: functionally significant lesions (quantitative flow ratio [QFR] ≤ 0.8), the number of stenotic coronary arteries (SCA, stenosis ≥ 50%) and the Gensini score. The correlation analyses were carried out between the CRF and the severity of the coronary artery disease. A ROC curve was plotted, and the AUC was calculated to distinguish the severe CAD and the non-severe CAD patients, as measured by the QFR, the number of SCA, and the Gensini score. Results: The VO2@AT and VO2@peak were inversely associated with the QFR. The VO2@AT, VO2@peak and VO2/kg@peak were associated with the number of SCA. Meanwhile, the VO2@AT, VO2/kg@AT, VO2@peak and VO2/kg@peak were associated with the Gensini score. An ROC analysis proved that a combination of traditional clinical risk factors and the VO2@peak/VO2prediction is valuable in predicting CAD severity. Conclusions: Our study demonstrated a strong and inverse association between CRF and the severity of CAD. A combination of traditional clinical risk factors and CRF is valuable in predicting CAD severity.

Oxygen pulse variation in symptomatic patients with suspected coronary artery disease: a diagnostic analysis

“…It is somewhat surprising that no differences were found in the remaining variables of CPET, including peak VO 2 and ∆VO 2 /∆WR, which are also considered to be related to myocardial ischemia ( 2 , 21 , 22 ). This finding might also be attributed to the differences in the patient populations between studies.…”

Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: A comparison of subjective and novel objective methodology

“…Cardiopulmonary exercise testing (CPET) allows for the non-invasive, objective quantification of cardiopulmonary fitness, and is thus held as the 'gold standard' methodology for evaluating functional capacity [1,2]. In contrast to more traditional assessments, such as ECG stress testing and the 6-minute walk test, CPET makes it possible to determine the potential pathophysiological mechanisms underlying exercise intolerance [2][3][4].…”

“…The utility of CPET as a diagnostic and prognostic tool in the evaluation of patients with coronary artery disease (CAD) and heart failure has received some attention [1][2][3][4][5]. In particular, an early plateau or inflection in the normal linear progression of oxygen pulse (O 2 Pulse) and oxygen consumption (VO 2 ) despite an increasing work-rate (WR) are suggested to be indicative of inducible and reversable ischaemia [2,4,[6][7][8][9].…”

The association between O2-pulse slope ratio and functional severity of coronary stenosis: A combined cardiopulmonary exercise testing and quantitative flow ratio study

“…The O 2 -pulse, derived from CPET, stands as one of the most valuable indicators of myocardial ischemia [16] , [17] , [18] , [19] . It represents the ratio of oxygen consumption (VO 2 ) to heart rate (HR), effectively reflecting increments in stroke volume and oxygen extraction [20] , [21] .…”