CHEST Guidelines-The-Value-of-Cardiopulmonary-Exercise-Testing-as-a

The-Value-of-Cardiopulmonary-Exercise-Testing-as-a

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The editorial by Richard Casaburi in CHEST discusses the significance of cardiopulmonary exercise testing (CPET) as a predictor of mortality in patients with heart failure (HF) with reduced ejection fraction. The analysis by Salvioni et al. on a considerable database of over 6,000 patients suggests that certain CPET variables help in determining prognosis. Patients were evaluated over a median of 4.2 years, and the study primarily focused on the anaerobic threshold, linking it to HF survival rates.

Casaburi highlights three key CPET variables: peak oxygen uptake, anaerobic threshold, and the pulmonary ventilation-CO2 output relationship (<em>VE- </em>VCO2). Peak oxygen uptake, while common and straightforward, is effort-dependent and can vary based on patient motivation. The anaerobic threshold, being effort-independent, offers significant prognostic value but can sometimes be subjective. Absence of a detectable anaerobic threshold indicates a poorer prognosis.

The <em>VE- </em>VCO2 relationship, similarly effort-independent, has shown good mortality prediction in patients with HF. It's influenced by factors like ventilatory control and lung gas exchange characteristics, with elevated VD/VT being a prevalent mechanism in HF. Prognostically, the combination of these measures slightly improves the accuracy over individual use, but Casaburi finds it modest.

In conclusion, CPET, once a pulmonologist's tool, is now instrumental for cardiologists in assessing HF prognosis and exercise intolerance. Although the combination of CPET measures does not significantly enhance prognostic information, it remains an essential aspect in the treatment and evaluation process for HF patients. Despite some controversies and challenges, individualized CPET analysis guides improved patient outcomes.

Keywords

cardiopulmonary exercise testing

heart failure

reduced ejection fraction

anaerobic threshold

peak oxygen uptake

VE-VCO2 relationship

mortality prediction

prognosis

exercise intolerance

Richard Casaburi