The Role of Exercise Testing in Pulmonary Vascular Disease : Diagnosis and Management - 02/02/21

Doi : 10.1016/j.ccm.2020.11.003

David Systrom, MD ^a,^{^{1
Present address: 75 Francis Street, PBB CA-3, Boston 02115.}}, Arabella Warren ^a,^{^{1
Present address: 75 Francis Street, PBB CA-3, Boston 02115.}}, Robert Naeije, MD, PhD ^b,^⁎
^a Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
^b Free University of Brussels, Brussels, Belgium

^∗Corresponding author. Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, Lennik Road 808, Brussels B-1070, Belgium,Department of PathophysiologyFaculty of MedicineFree University of BrusselsLennik Road 808BrusselsB-1070Belgium

Résumé

Exercise intolerance is the dominant symptom of pulmonary hypertension (PH). The gold standard for the estimation of exercise capacity is a cycle ergometer incremental cardiopulmonary exercise test (CPET). The main clinical variables generated by a CPET are peak oxygen uptake (Vo2peak), ventilatory equivalents for carbon dioxide (VE/Vco₂), systolic blood pressure, oxygen (O2) pulse, and chronotropic responses. PH is associated with hyperventilation at rest and at exercise, and an increase in physiologic dead space. Maximal cardiac output depends on right ventricular function and critically determines a PH patient’s exercise capacity. Dynamic arterial O2 desaturation can also depress the Vo2peak.

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Keywords : Exercise intolerance, Pulmonary hypertension, Exercise capacity, Cardiopulmonary exercise test, Unexplained dyspnea, Pulmonary vascular disease