Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations

Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms....

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Autores: Neder, José Alberto, Phillips, Devin B., Marillier, Mathieu, Bernard, Anne-Catherine, Berton, Danilo Cortozi, O'Donnell, Denis Einan
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:Brasil
Institución:Universidade Federal do Rio Grande do Sul (UFRGS)
Repositorio:Repositório Institucional da UFRGS
Idioma:inglés
OAI Identifier:oai:www.lume.ufrgs.br:10183/280548
Acceso en línea:http://hdl.handle.net/10183/280548
Access Level:acceso abierto
Palabra clave:Exercício físico
Dispneia
Testes de função respiratória
Exercise
Dyspnea
Lung function
Cardiopulmonal capacity
Exercise test interpretation
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spelling 2024-10-26T06:56:08Z20211664-042Xhttp://hdl.handle.net/10183/280548001206524Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V˙O2) despite a low peak WR. Among the determinants of V˙O2, only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O2 delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that “the lungs” are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased “wasted” ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO2 might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician.application/pdfengFrontiers in physiology. Lausanne. Vol. 12 (June 2021), 552000, 7 p.Exercício físicoDispneiaTestes de função respiratóriaExerciseDyspneaLung functionCardiopulmonal capacityExercise test interpretationClinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitationsEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSNeder, José AlbertoPhillips, Devin B.Marillier, MathieuBernard, Anne-CatherineBerton, Danilo CortoziO'Donnell, Denis EinanTEXT001206524.pdf.txt001206524.pdf.txtExtracted Texttext/plain41458http://www.lume.ufrgs.br/bitstream/10183/280548/2/001206524.pdf.txtbd8829ffe1b9e588569148a6faaeb276MD52ORIGINAL001206524.pdfTexto completo (inglês)application/pdf1418742http://www.lume.ufrgs.br/bitstream/10183/280548/1/001206524.pdfa4551bbb1497f97275707bd54f1185ffMD5110183/2805482024-10-27 06:50:48.271267oai:www.lume.ufrgs.br:10183/280548Repositório InstitucionalPUBhttps://lume.ufrgs.br/oai/requestlume@ufrgs.bropendoar:2024-10-27T09:50:48Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false
dc.title.pt_BR.fl_str_mv Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
title Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
spellingShingle Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
Neder, José Alberto
Exercício físico
Dispneia
Testes de função respiratória
Exercise
Dyspnea
Lung function
Cardiopulmonal capacity
Exercise test interpretation
title_short Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
title_full Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
title_fullStr Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
title_full_unstemmed Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
title_sort Clinical interpretation of cardiopulmonary exercise testing : current pitfalls and limitations
dc.creator.none.fl_str_mv Neder, José Alberto
Phillips, Devin B.
Marillier, Mathieu
Bernard, Anne-Catherine
Berton, Danilo Cortozi
O'Donnell, Denis Einan
author Neder, José Alberto
author_facet Neder, José Alberto
Phillips, Devin B.
Marillier, Mathieu
Bernard, Anne-Catherine
Berton, Danilo Cortozi
O'Donnell, Denis Einan
author_role author
author2 Phillips, Devin B.
Marillier, Mathieu
Bernard, Anne-Catherine
Berton, Danilo Cortozi
O'Donnell, Denis Einan
author2_role author
author
author
author
author
dc.subject.por.fl_str_mv Exercício físico
Dispneia
Testes de função respiratória
topic Exercício físico
Dispneia
Testes de função respiratória
Exercise
Dyspnea
Lung function
Cardiopulmonal capacity
Exercise test interpretation
dc.subject.eng.fl_str_mv Exercise
Dyspnea
Lung function
Cardiopulmonal capacity
Exercise test interpretation
description Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V˙O2) despite a low peak WR. Among the determinants of V˙O2, only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O2 delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that “the lungs” are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased “wasted” ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO2 might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician.
publishDate 2021
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dc.date.accessioned.fl_str_mv 2024-10-26T06:56:08Z
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dc.language.iso.fl_str_mv eng
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dc.relation.ispartof.pt_BR.fl_str_mv Frontiers in physiology. Lausanne. Vol. 12 (June 2021), 552000, 7 p.
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