➢ Breathlessness ➢ Leg discomfort
Modified Borg CR-10 Scale
Indications for CPET
Evaluation of dyspnea
➢ Distinguish cardiac vs pulmonary vs peripheral limitation vs other ➢ Detection of exercise-induced bronchoconstriction ➢ Detection of exertional desaturation
Pulmonary rehabilitation
➢ Exercise intensity/prescription ➢ Response to participation
Pre-op evaluation and risk stratification Prognostication of life expectancy Disability determination Fitness evaluation Diagnosis Assess response to therapy
CPET 心肺运动试验
What is CPET?
9
Symptom-limited exercise test
Measure airflow, SpO2, and expired oxygen and carbon dioxide
Allows calculation of peak oxygen consumption, anaerobic threshold
Mortality in CF Patients
Nixon et al; NEJM 327: 1785; 1992. Followed 109 patients with CF for 8 yrs from CPET
➢ Peak VO2 >81% predicted: 83% survival ➢ Peak VO2 59-81% predicted: 51% survival ➢ Peak VO2 <59% predicted: 28% survival
➢ 1-yr survival 47% ➢ 2-yr survival 32%
CPET to Predict Risk of Lung Resection in Lung Cancer
Lim et al; Thorax 65:iii1, 2010 Alberts et al; Chest 132:1s, 2007 Balady et al; Circulation 122:191, 2010
Clinical Exercise Tests
6-min walk test
➢ Submaximal
Shuttle walk test
➢ Incremental, maximal, symptom-limited
Exercise bronchoprovocation Exertional oximetry Cardiac stress test CPET
equivalent, heart rate reserve, breathing reserve, oxygen pulse Pattern of CPET results COPD vs CHF
Rationale for Exercise Testing
Cardiopulmonary measurements obtained at rest may not estimate functional capacity reliably
Karlman Wasserman
Coupling of External Ventilation and Cellular Metabolism
Adaptations of Wasserman’s Gears
General Mechanisms of Exercise Limitation
Cardiopulmonary Exercise Testing
1 MITCHELL HOROWITZ
CPET 心肺运动试验
Outline
Description of CPET Who should and who should not get CPET When to terminate CPET Exercise physiology Define terms: respiratory exchange ratio, ventilatory
Mortality in CHF Patients
Mancini et al; Circulation 83: 778; 1991. Peak VO2 >14 ml/kg/min:
➢ 1-yr survival 94% ➢ 2-yr survival 84%
Peak VO2 ≤14 ml/kg/min:
8
Peripheral
Inactivity Atrophy Neuromuscular dysfunction Reduced oxidative capacity
of skeletal muscle Malnutral Environmental
Pulmonary
Ventilatory Respiratory muscle
dysfunction Impaired gas exchange
Cardiovascular
Reduced stroke volume Abnormal HR response Circulatory abnormality Blood abnormality
CPET 心肺运动试验
Components of Integrated CPET
Symptom-limited ECG
➢ HR
Measure expired gas
➢ Oxygen consumption ➢ CO2 production ➢ Minute ventilation
SpO2 or PO2 Perceptual responses