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Our approach to interpretation of cardiopulmonary exercise tests in adults*

Our approach to interpretation of cardiopulmonary exercise tests in adults*

CPET: cardiopulmonary exercise test; RER: respiratory exchange ratio; VCO2: carbon dioxide output (L/minute); VO2: oxygen output (L/minute); FVL: flow volume loop; IC: inspiratory capacity; AT: anaerobic threshold; OUES: oxygen uptake efficiency slope (slope of VO2 versus logVE); ILD: interstitial lung disease; FVC: forced vital capacity; VD/VT: proportion of dead space ventilation per tidal volume breath; BP: blood pressure; HR: heart rate; VE: minute ventilation; ECG: electrocardiogram; SaO2: arterial oxygen saturation; A-a: alveolar-arterial; MVV: maximum voluntary ventilation; VEMAX: maximum minute ventilation at peak exercise (L/minute); PE: pulmonary embolism.

* For use with UpToDate content on cardiopulmonary exercise testing. This algorithm is intended to provide a systematic approach to interpretation of CPET data. The results should be considered in the clinical context. Some patients may have more than one cause of dyspnea, causing a mixed picture.

¶ There can be a discrepancy between these endpoints. Maximal metabolic capacity during exercise is assessed by the peak VO2, whereas the maximal functional capacity during exercise is assessed by the peak work.

Δ Mild pulmonary vascular or parenchymal diseases, most frequently early emphysema or ILD, PE, and pulmonary vasculitis, can sometimes result in impaired exercise performance due to abnormal gas exchange without ventilatory or cardiovascular limitation. These diagnoses should be considered in patients with this pattern.

◊ OUES normally is ≥1.47. It is decreased when exercise is limited by cardiac causes or mitochondrial myopathy.

§ Pulmonary hypertension may be due to several causes, including pulmonary arterial hypertension, heart failure, destructive lung disease, or thromboembolic disease.

¥ Evaluation of possible mitochondrial myopathy may include genetic testing and/or muscle biopsy.

‡ Breathing reserve is 1 – ([MVV – VEMAX]/MVV) × 100. Normal is 30 to 40%.
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