Pierantonio Laveneziana, Marcello Di Paolo  and Paolo Palange

Eur Respir Rev 2021; 30: 200187 [https://doi.org/10.1183/16000617.0187-2020].

ABSTRACT Cardiopulmonary exercise testing (CPET) has long been used as diagnostic tool for cardiac
diseases. During recent years CPET has been proven to be additionally useful for 1) distinguishing
between normal and abnormal responses to exercise; 2) determining peak oxygen uptake and level of
disability; 3) identifying factors contributing to dyspnoea and exercise limitation; 4) differentiating between
ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular, metabolic and peripheral
muscle causes of exercise intolerance; 5) identifying anomalies of ventilatory (respiratory mechanics and
pulmonary gas exchange), cardiovascular and metabolic systems, as well as peripheral muscle
and psychological disorders; 6) screening for coexistent ischaemic heart disease, peripheral vascular disease
and arterial hypoxaemia; 7) assisting in planning individualised exercise training; 8) generating prognostic
information; and 9) objectively evaluating the impact of therapeutic interventions.
As such, CPET is an essential part of patients’ clinical assessment. This article belongs to the special
series on the “Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders”,
addressed to clinicians, physiologists and researchers, and aims at encouraging them to get acquainted
with CPET in order to help and orient the clinical decision concerning individual patients.
Introduction