Cardiopulmonary Exercise Testing

• EACPR/AHA Scientific Statement

Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

1. Marco Guazzi, Co-Chair¹*; 
2. Volker Adams²; 
3. Viviane Conraads³;
4. Martin Halle⁴; 
5. Alessandro Mezzani⁵; 
6. Luc Vanhees⁶; 
7. Ross Arena, Co-Chair⁷; 
8. Gerald F. Fletcher⁸; 
9. Daniel E. Forman⁹; 
10. Dalane W. Kitzman¹⁰;
11. Carl J. Lavie¹¹¹²; 
12. Jonathan Myers¹³

+Author Affiliations

1. ¹Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, P.za Malan, 2, 20097, Milan, Italy
2. ²Department of Cardiology, University Leipzig–Heart Center Leipzig, Leipzig, Germany
3. ³Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
4. ⁴Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany; Munich Heart Association, Munich, Germany
5. ⁵Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, S. Maugeri Foundation IRCCS, Scientific Institute of Veruno, Veruno (NO), Italy
6. ⁶Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven (University of Leuven), Leuven, Belgium
7. ⁷Department of Orthopaedics and Rehabilitation – Division of Physical Therapy and Department of Internal Medicine – Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, NM, USA
8. ⁸Mayo Clinic College of Medicine, Jacksonville, FL, USA
9. ⁹Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
10. ¹⁰Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
11. ¹¹Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
12. ¹²Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
13. ¹³Division of Cardiology, VA Palo Alto Health Care System, Stanford University, Palo Alto, CA, USA.

1. ↵*Corresponding author. Tel: +39 02 52774966, Fax: +39 02 52774966, E-mail:marco.guazzi@unimi.it.

Key Words:

• AHA Scientific Statements
• exercise testing
• ***********************************

• Introduction

  From an evidence-based perspective, cardiopulmonary exercise testing (CPX) is a well-supported assessment technique in both the United States (US) and Europe. The combination of standard exercise testing (ET) (ie, progressive exercise provocation in association with serial electrocardiograms [ECG], hemodynamics, oxygen saturation, and subjective symptoms) and measurement of ventilatory gas exchange amounts to a superior method to: 1) accurately quantify cardiorespiratory fitness (CRF), 2) delineate the physiologic system(s) underlying exercise responses, which can be applied as a means to identify the exercise-limiting pathophysiologic mechanism(s) and/or performance differences, and 3) formulate function-based prognostic stratification. Cardiopulmonary ET certainly carries an additional cost as well as competency requirements and is not an essential component of evaluation in all patient populations. However, there are several conditions of confirmed, suspected, or unknown etiology where the data gained from this form of ET is highly valuable in terms of clinical decision making.^1/.../