Cardiopulmonary Exercise Testing in Heart Failure

Myers, Jonathan;
Arena, Ross; Cahalin, Lawarence P.; Labate, Valentina; Guazzi, Marco.
Current Problems in Cardiology, 20150101,
Abstract: A growing body of literature has underscored the value of
ventilatory gas exchange techniques during exercise testing (commonly
termed cardiopulmonary exercise testing, or CPX) and their applications
in the management of patients with heart failure (HF). The added
precision provided by this technology is useful in terms of
understanding the physiology and mechanisms underlying exercise
intolerance in HF, quantifying the response to therapy, evaluating
disability, making activity recommendations, and quantifying the
response to exercise training. Importantly, a wealth of data has been
published in recent years on the prognostic utility of CPX in patients
with HF. These studies have highlighted the concept that indices of
ventilatory inefficiency, such as the VE/VCO2slope and oscillatory
breathing, are particularly powerful in stratifying risk in HF. This
article provides an overview of the clinical utility of CPX in patients
with HF, including the applications of ventilatory inefficiency during
exercise, the role of the pulmonary system in HF, respiratory muscle
performance (RMP), and the application of CPX as part of a
comprehensive clinical and exercise test evaluation.