Computerized Cardiopulmonary Exercise Testing

Cardiopulmonary Exercise Testing

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Enter your mobile number or email address below and we'll send you a link to download the free Kindle App. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Would you like to tell us about a lower price? If you are a seller for this product, would you like to suggest updates through seller support? Also, in other medical disciplines, ergospirometry lost its importance.

The diverse, quirky and mostly forgotten history of Pulmonary Function testing

Wasserman in Los Angeles is to be credited for having further improved the method to its present standard, a computerized, on-line measuring and practicable cardiopulmonary exercise testing procedure. The working groups of W. Hollmann, Cologne, and K. Wasserman, Los Angeles, determined normal values for the gas-exchange parameters and derived values for healthy normals in large populations.

Many cardiologists, working, for example in myocardial failure or with rate-adaptive pacemakers, belong to those who recommended the modem, computerized ergo spirometry. Read more Read less.

The diverse, quirky and mostly forgotten history of Pulmonary Function testing

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Cardiopulmonary Exercise Testing - Medical Clinical Policy Bulletins | Aetna

Valid only on your first 2 online payments. Cashback will be credited as Amazon Pay balance within 10 days from purchase. The demographic and clinical characteristics of the study population at the time of IPF diagnosis are given in Table 1. All patients were treatment naive when entering the study, while most of them received no treatment for IPF in the observational period as well.

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None of the patients included in the study were on treatment with beta-blockers. At the time of reporting seventeen patients were still alive Figure 1. Follow-up time ranged from 9 months to 64 months. Mean survival was All deaths were disease related. Twenty-one patients reached anaerobic threshold. Among the 4 patients who did not reach AT, one stopped due to leg discomfort and the rest due to dyspnea. Additionally, it is worth mentioning that when including the Distance in a Cox proportional hazards model, the R-squared of this model is 0.

In this study, we aimed to evaluate the role of exercise testing in the outcome of IPF patients. The results of the present study are partly in accordance with the ones of Fell and colleagues who demonstrated that cardiopulmonary exercise testing adds significant prognostic information for patients with IPF and identified that IPF patients with a baseline maximal oxygen uptake less than 8. For example, patients in the study of Fell and colleagues who were recruited from previous study protocols have a more impaired functional status as expressed by FVC values and were under treatment with several regimens contrary to the present study where most patients are treatment naive.

On the other hand, in the study of Gay and coworkers, VO 2 peak measurement among the factors of a composite clinical, radiographic, and physiologic scoring system for IPF patients failed to predict survival [ 25 ], while Erbes and colleagues found that gas transfer during spiroergometric exercise was not predictive of prognosis in IPF [ 26 ].

However, most of those studies were retrospective in design. The significant correlation of CPET variables with survival indicates that exercise limitation has a tremendous effect on this group of patients. In IPF, fibrotic lung parenchymal damage leads to multiple physiologic derangements such as low tidal volume, the rapid shallow breathing pattern, and the detrimental dead space ventilation. The above disorders result in worsening gas exchange during exercise sooner or later in every patient with IPF. Exercise limitation is further aggravated by pulmonary vascular derangements, myocardial disturbances, and peripheral muscle weakness that are commonly described in IPF patients [ 13 ].

This finding could be explained by the fact that both values reflect very robustly and in a complementary way the pathophysiology of exercise limitation in IPF patients. Peak oxygen consumption on the one hand reflects the attainment of a limitation at some point in the oxygen conductance pathway due to the physiologic derangements already described in IPF. On the other hand, DLCO provides information regarding the above-mentioned physiologic derangements, that is, the gas transfer capability which is significantly impaired in IPF and predicts oxygen desaturation during exercise [ 11 , 12 , 29 ].

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The evaluation of multidimensional models of survival, combining variables that independently predict mortality and share common underlying physiologic determinants, has already been studied in respiratory diseases such as COPD [ 30 ]. In IPF, most composite indices that have been identified by now usually derive from the extent of fibrosis on HRCT, pulmonary function test variables, and clinical parameters such as age and gender, thus precluding the prognostic strength of exercise data [ 12 , 31 , 32 ].

Only in the study of King Jr.

Nevertheless, this score is not easy to perform in everyday clinical practice and it partially depends on subjective measurements such as finger clubbing. The role of the distance walked is also highlighted, although contradictory conclusions exist on the field [ 18 , 33 ]. Based on the results of both studies, we believe that the role of CPET in the evaluation of survival in IPF patients could be upgraded. In the present study, further evaluation of the interdependence of both maximal and submaximal exercise test variables with resting functional measurements has demonstrated a strong and significant association between them.

The restrictive defect encountered in this group of patients leads to the inability to expand tidal volume appropriately and therefore to low breathing reserve during the increased metabolic demand of exercise which is a major determinant of exercise limitation in IPF [ 29 , 34 ]. Our study has a number of limitations, the most important being the relatively short observation period and in consequence the limited mortality rate.

Another limitation is the moderate number of patients included mostly due to the rarity of the disease with a prevalence of 3. However, it is a prospective, single centre study based on a well-selected group of IPF patients most of who are treatment naive, in contrast to the majority of already existing studies in the literature which are retrospective in design and examine patients that participate in various treatment protocols that could have an undefined impact on their survival.

The predictive role of peak oxygen consumption is further reinforced when integrated with DLCO due to the fact that both variables share major underlying physiologic determinants of exercise limitation in IPF. All authors would like to express their gratitude to Professor Joseph Milic-Emili for providing them with invaluable help and constant inspiration all those years.

Indexed in Web of Science. Subscribe to Table of Contents Alerts. Table of Contents Alerts. Introduction Idiopathic pulmonary fibrosis IPF is an irreversibly progressive lung disease with substantial morbidity and mortality. Materials and Methods 2.

Results The population studied consisted of 25 patients. The cumulative Kaplan-Meier survival plot. Overall death risk through the Cox proportional hazards models.

Data are described using standard box plots with medians interquartile range. Risk was found to be significantly differentiated between dead and alive with , , and , respectively. A threshold of mortality was identified.

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