Chaudhry S;Chicago, Illinois, USA & University of Toronto, Toronto, Canada.
Kumar N; Arena R; Verma S

Current Opinion in Cardiology. 38(6):552-572, 2023 Nov 01.

PURPOSE OF REVIEW: Cardiopulmonary exercise testing (CPET) is the gold
standard for directly assessing cardiorespiratory fitness (CRF) and has a
relatively new and evolving role in evaluating atherosclerotic heart
disease, particularly in detecting cardiac dysfunction caused by ischemic
heart disease. The purpose of this review is to assess the current
literature on the link between cardiovascular (CV) risk factors, cardiac
dysfunction and CRF assessed by CPET.
RECENT FINDINGS: We summarize the basics of exercise physiology and the
key determinants of CRF. Prognostically, several studies have been
published relating directly measured CRF by CPET and outcomes allowing for
more precise risk assessment. Diagnostically, this review describes in
detail what is considered healthy and abnormal cardiac function assessed
by CPET. New studies demonstrate that cardiac dysfunction on CPET is a
common finding in asymptomatic individuals and is associated with CV risk
factors and lower CRF. This review covers how key CPET parameters change
as individuals transition from the asymptomatic to the symptomatic stage
with progressively decreasing CRF. Finally, a supplement with case studies
with long-term longitudinal data demonstrating how CPET can be used in
daily clinical decision making is presented.
SUMMARY: In summary, CPET is a powerful tool to provide individualized CV
risk assessment, monitor the effectiveness of therapeutic interventions,
and provide meaningful feedback to help patients guide their path to
improve CRF when routinely used in the outpatient setting.