Cardiopulmonary exercise testing: Practical and clinical concepts

Cardiopulmonary exercise testing (CPET) is a comprehensive diagnostic technique which emphasizes not only parameters of cardiac function but integrates this with the ventilatory response, Improvements in technology over the past 15 years have broadened the availability of this technology in clinical practice. Recent work has clarified normal cardiac and respiratory responses. The limitations of anaerobic threshold determination have been highlighted although the value of measuring maximal aerobic capacity has been confirmed. Assessment of ventilatory response must include a description of mechanical ventilatory function using minute ventilation and, potentially, tidal flow volume loops during exercise, In addition, examination of gas exchange is recommended to fully assess ventilatory response. The role of peripheral muscle function during the exercise response has been confirmed in normal subjects and individuals with mitochondrial disorders, These data are reviewed as are those which confirm the clinical value of CPET in the evaluation of dyspnea, chronic airflow obstruction, restrictive lung disease, disability impairment, preoperative evaluation and prognostication in advanced cardiac failure.