A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease: a primer for cardiologists. [Review]

Chaudhry S; Arena R; Bhatt DL; Verma S; Kumar N.

Current Opinion in Cardiology. 33(2):168-177, 2018 03.

PURPOSE OF REVIEW: There is growing clinical interest for the use of
cardiopulmonary exercise testing (CPET) to evaluate patients with or
suspected coronary artery disease (CAD). With mounting evidence, this
concise review with relevant teaching cases helps to illustrate how to
integrate CPET data into real world patient care.
RECENT FINDINGS: CPET provides a novel and purely physiological basis to
identify cardiac dysfunction in symptomatic patients with both
obstructive-CAD and nonobstructive-CAD (NO-CAD). In many cases, abnormal
cardiac response on CPET may be the only objective evidence of potentially
undertreated ischemic heart disease. When symptomatic patients have NO-CAD
on coronary angiogram, they are still at increased risk for cardiovascular
events. This problem appears to be more common in women than men and may
warrant more aggressive risk factor modification. As the main intervention
is lifestyle (diet, smoking cessation, exercise) and medical therapy
(statins, angiotensin-converting enzyme inhibitors, beta-blockers), serial
CPET testing enables close surveillance of cardiovascular function and is
responsive to clinical status.
SUMMARY: CPET can enhance outpatient evaluation and management of CAD.
Diagnostically, it can help to identify physiologically significant
obstructive-CAD and NO-CAD in patients with normal routine cardiac
testing. CPET may be of particular value in symptomatic women with NO-CAD.
Prognostically, precise quantification of improvements in exercise
capacity may help to improve long-term lifestyle and medication adherence
for this chronic condition.