Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part I: definition of cardiopulmonary exercise testing parameters for appropriate use in chronic heart failure

Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrated response to exercise involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems. This information cannot be obtained through investigation of the individual organ systems in isolation. The non-invasive, dynamic physiological overview permits the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision making. The use of CPET in management of the chronic heart failure patient is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status and prognosis are predicted better by indices of exercise tolerance than by resting measurements. Our aim is to produce a statement which provides recommendations on the interpretation and clinical application of CPET in heart failure, based on contemporary scientific knowledge and technical advances: the focus is on clinical indications, issues of standardization, and interpretative strategies for CPET

Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction. Recommendations for performance and interpretation

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Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Part II: How to perform cardiopulmonary exercise testing in chronic heart failure

Basic and practical information related to equipment, methodology, exercise protocols, conduct of the test and quality control issues for cardiopulmonary exercise testing (CPET) will be addressed in this II part of the statement. CPET users have the responsibility for assuring that measurements remain accurate. CPT, especially when it features breath-by-breath gas exchange analysis, requires meticulous attention to calibration procedures to assure accurate and reproducible measurements. Skills and knowledge of personnel for supervision and test interpretation, as well as patient preparation and information are key features for a correct CPET conduction: all these issues will be faced. Finally, after the test, the investigator needs to format the results in a manner that optimises the ability to discriminate essential response features; that is, to establish 'interpretive clusters' of the variables of interest. An example of a cardiopulmonary summary exercise test data report will be provided, defining the most important information that should be incorporated in a final report

Speeding of pulmonary V\u2019O2 on-kinetics by light-to-moderate intensity aerobic exercise training in chronic heart failure: clinical and pathophysiological correlates.

Background: Pulmonary VO2 on-kinetics during light-to-moderate-intensity constant-work-rate exercise, an experimental model mirroring energetic transitions during daily activities, has been shown to speed up with aerobic exercise training (AET) in normal subjects, but scant data are available in chronic heart failure (CHF). Methods and results: Thirty CHF patients were randomized to 3 months of light-to-moderate-intensity AET (CHF-AET) or control (CHF-C). Baseline and end-protocol evaluations included i) one incremental cardiopulmonary exercise test with near infrared spectroscopy analysis of peak deoxygenated hemoglobin+myoglobin concentration changes (\u394[deoxy(Hb+Mb)]) in vastus lateralis muscle, ii) 8 light-to-moderate-intensity constant-work-rate exercise tests for VO2 on-kinetics phase I duration, phase II \u3c4, and mean response time (MRT) assessment, and iii) circulating endothelial progenitor cell (EPC) measurement. Reference values were obtained in 7 age-matched normals (N). At end-protocol, phase I duration, phase II \u3c4, and MRT were significantly reduced ( 1212%, 1222%, and 1219%, respectively) and peak VO2, peak \u394[deoxy(Hb+Mb)], and EPCs increased (9%, 20%, and 98%, respectively) in CHF-AET, but not in CHF-C. Peak \u394[deoxy(Hb+Mb)] and EPCs relative increase correlated significantly to that of peak VO2 (r=0.61 and 0.64, respectively, pb0.05). Conclusions: Light-to-moderate-intensity AET determined a near-normalization of pulmonary VO2 on-kinetics in CHF patients. Such a marked plasticity has important implications for AET intensity prescription, especially in patients more functionally limited and with high exercise-related risk. The AET-induced simultaneous improvement of phase I and phase II, associated with an increase of peak peripheral oxygen extraction and EPCs, supportsmicrocirculatory O2 delivery impairment as a key factor determining exercise intolerance in CHF

Reduced exercise capacity in early-stage amyotrophic lateral sclerosis: role of skeletal muscle.

Our objective was to correlate skeletal muscle mass (SM) with cardiopulmonary exercise testing (CPET) descriptors of exercise capacity in patients with amyotrophic lateral sclerosis (ALS) and compare ALS CPET data with those of patients with mitochondrial myopathy (MM) and normal subjects (N). Twenty-four early-stage ALS patients (63 +/-11 years) underwent bioelectrical impedance analysis of body composition, resting spirometry, and ramp CPET. Six MM and six N were used as controls (56 +/- 7 and 63 +/- 4 years, respectively). Results showed that ALS SM index was similar to that of N (9.0 +/- 2.1 kg/m2 vs. 10.4 +/- 1.9 kg/m2 , respectively; p = n.s.), whereas peak VO2 /kg SM was signifi cantly lower (41.5 +/- 11.6 ml/kg/min vs. 57.8 +/- 7.5 ml/kg/min, respectively; p < 0.01). However, the heart rate/VO 2 slope did not differ between ALS and N, being significantly higher in MM than in both ALS and N (6.1 +/- 1.4 beats/ml/kg/min vs. 4.2 +/- 1.1 beats/ml/kg/min vs. 3.8 +/- 2.0 beats/ml/kg/min, respectively; both p < 0.01), excluding a marked skeletal muscle metabolic impairment in ALS. Neither cardiovascular nor ventilatory dysfunction was detected in ALS. Early-stage ALS patients show a SM similar to N, but with a reduced peak VO2/kg SM. Such a reduced peripheral O2 utilization is consistent with deconditioning as the main cause of impaired exercise capacity in this population

Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation

Cardiopulmonary exercise testing (CPET) is a methodology that has profoundly affected the approach to patients' functional evaluation, linking performance and physiological parameters to the underlying metabolic substratum and providing highly reproducible exercise capacity descriptors. This study provides professionals with an up-to-date review of the rationale sustaining the use of CPET for functional evaluation of cardiac patients in both the clinical and research settings, describing parameters obtainable either from ramp incremental or step constant-power CPET and illustrating the wealth of information obtainable through an experienced use of this powerful tool. The choice of parameters to be measured will depend on the specific goals of functional evaluation in the individual patient, namely, exercise tolerance assessment, training prescription, treatment efficacy evaluation, and/or investigation of exercise-induced adaptations of the oxygen transport/ utilization system. The full potentialities of CPET in the clinical and research setting still remain largely underused and strong efforts are recommended to promote a more widespread use of CPET in the functional evaluation of cardiac patients

Exercise intolerance in chronic heart failure: mechanisms and therapies. Part I.

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