Chest
Volume 99, Issue 4, April 1991, Pages 981-992
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Impact of Integrative Cardiopulmonary Exercise Testing on Clinical Decision Making

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What Is an Integrative Cardiopulmonary Exercise Test?

The integrative cardiopulmonary exercise test allows the simultaneous measurement during known exercise stress of the following: (1) the balance between oxygen supply to the myocardium and myocardial oxygen requirement, assessed primarily from changes indicating ischemia on the electrocardiogram; (2) the adequacy of oxygen delivery (a cardiovascular function) to the muscles of locomotion; and (3) the ability to transfer O2 into and eliminate CO2 from the blood (a pulmonary and cardiovascular

What Does Gas Exchange during Exercise Measure?

In practical terms, there are two clinical questions asked of the integrative cardiopulmonary exercise test: (1) Can the patient perform exercise at the level predicted for a normal person of similar age and size? (2) If exercise capacity is abnormally low, what is the cause of that reduction? These questions are addressed by measuring such important gas exchange variables as the maximum or peak O2 uptake, CO2 output, the anaerobic threshold (AT), and others. These variables, when compared with

Interpreting Gas Exchange Measurments During Exercise

The responses of the cardiovascular system (heart and systemic circulation), pulmonary system (lungs and pulmonary circulation), and the exercising muscles must be closely coupled during exercise. Thus, there is interaction between the organs requiring increased transport of O2 and CO2 and the organ systems responsible for delivery of O2 and CO2 to and from the atmosphere. This is conceptualized in Figure 1. From this scheme of interaction between organ systems comes two important

Impact of the Integrative Cardiopulmonary Exercise Test on Clinical Decision-Making

As discussed, exercise requires the closely coupled interaction between the various organ systems needed for gas transport between the air and the exercising muscles. Because the integrative cardiopulmonary exercise test may be useful for identifying the mechanism of exercise impairment or the degree of impairment, the integrative cardiopulmonary exercise test is likely to be of value as a screening test for patients with exercise limitation or exertional dyspnea.

Because of the quantitative

When Should Integrative Cardiopulmonary Exercise Testing Be Used?

The integrative cardiopulmonary exercise test can be thought of as having two components. The first is the exercise metabolic stress that amplifies the responses of the organ systems that interact to allow exercise to be performed. The second is the measurement of the gas exchange variables that allow identification of the work capacity of the subject and the organ systems that limit exercise, if any. These two features make the integrative cardiopulmonary exercise test a unique application of

What Questions About Integrative Cardiopulmonary Exercise Testing Should Be Addressed at This Time?

The physiologic basis for integrative cardiopulmonary exercise testing is well established, while the clinical basis for such testing is fast becoming established. This process can be expedited in several ways. First, methodology should be clearly reported in studies describing clinical uses. These include the methods of measuring gas exchange and the type of exercise protocol employed. A potential advantage would be the adoption of standard protocols for treadmill and cycle exercise and the

Conclusion

Integrative cardiopulmonary exercise testing is an important application of physiology to clinical medicine. The understanding that gas exchange into and out of the lungs during exercise provides information about the function of the heart, lungs, pulmonary circulation, and systemic circulation and their interactions has led to increasing use of exercise testing in a variety of medical conditions. At present, there is considerable evidence supporting the use of integrative cardiopulmonary

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