Cardiopulmonary Exercise Testing in Adults

(Circulation. 2010;122:191-225.)
© 2010 American Heart Association, Inc. 

AHA Scientific Statement

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

A Scientific Statement From the American Heart Association

Gary J. Balady, MD, FAHA, Chair; Ross Arena, PhD, FAHA; Kathy Sietsema, MD; Jonathan Myers, PhD, FAHA;Lola Coke, RN, PhD; Gerald F. Fletcher, MD, FAHA; Daniel Forman, MD; Barry Franklin, PhD, FAHA;Marco Guazzi, MD, PhD; Martha Gulati, MD; Steven J. Keteyian, PhD; Carl J. Lavie, MD; Richard Macko, MD;Donna Mancini, MD; Richard V. Milani, MD, FAHA, on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention;Council on Peripheral Vascular Disease; Interdisciplinary Council on Quality of Care and Outcomes Research
Key Words: AHA Scientific Statements • diagnosis • exercise • heart failure • prognosis • exercise test • blood gas analysis

	Introduction

Exercise testing remains a remarkably durable and versatile tool that provides valuable diagnostic and prognostic informationregarding patients with cardiovascular and pulmonary disease. Exercise testing has been available for more than a half centuryand, like many other cardiovascular procedures, has evolved in its technology and scope. When combined with exercise testing,adjunctive imaging modalities offer greater diagnostic accuracy, additional information regarding cardiac structure and function,and additional prognostic information. Similarly, the addition of ventilatory gas exchange measurements during exercise testingprovides a wide array of unique and clinically useful incremental information that heretofore has been poorly understood and underutilized by the practicing clinician. The reasons for this are many and include the requirement for additional equipment (cardiopulmonary exercise testing [CPX] systems), personnel who are proficient in the administration and interpretation of these tests, limited or absence of training of cardiovascular specialists and limited training by pulmonary specialists in this technique, and the lack of understanding of the value of CPX by practicing clinicians./.../