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Exercise testing beyond the ST segment

  • Diagnostic role of cardiopulmonary exercise testing, presented by A Cohen-Solal (Paris, FR) - Slides 
  • Role of cardiopulmonary exercise testing in exercise prescription, presented by J Myers (Palo Alto, US) - Slides 
  • What can we learn from the heart rate response during exercise and recovery? Presented by X Jouven (Paris, FR) - Slides 
  • Is there a place for echocardiography during exercise testing? Presented by A G Fraser (Cardiff, GB) - Slides 

Diagnostic role of cardiopulmonary exercise testing

Professor Alan Cohen-Solal nicely summarized the indications for and advantages of performing cardiopulmonary exercise testing (CPX) in cardiac patients. Indeed, information gained in addition to a standard exercise testing include peak oxygen uptake (highest VO2 achieved during CPX); maximal oxygen uptake (VO2max; i.e. value measured when VO2 remains stable despite a progressive increase in exercise intensity = peak aerobic capacity); breathing reserve (reserve of ventilatory system as compared to voluntary ventilation); anaerobic threshold (highest oxygen uptake without increase in blood lactate); respiratory exchange ratio (ratio of VCO2 / VO2), oxygen saturation (percentage of hemoglobin that is saturated with oxygen); O2 pulse (O2 consumed from blood delivered to tissues per heartbeat); and ventilation/carbon dioxide production ratio (VE/VCO2; additional reading: Milani RV, Circulation. 2004;110:e27-e31). Professor Cohen-Solal also showed several examples how CPX could be used for the evaluation of exertional dyspnea, risk stratification and prognosis in heart failure, determination of need for surgical repair as well as response to treatment of patients with congenital heart disease, or assess the functional significance of stenotic or regurgitant valvular heart disease.

Role of cardiopulmonary exercise testing in exercise prescription

Professor Jonathan Myers from Stanford, USA gave several examples of how CPX could help to prescribe an individually tailored exercise prescription. He postulated that patients but also persons who include exercise as a part of a healthy lifestyle could benefit from an exact training prescription, so that they would efficiently train and thus stay motivated to exercise for a lifetime. Professor Myers also demonstrated how much more accurate CPX measurements are in comparison to watts achieved during exercise testing or merely measured walking distance.

Taken together, the presentations by Prof Cohen-Solal and Prof Myers make one wonder how CPX could have been so successfully hidden from cardiologists, that we do continue to ignore the advantages of this testing instrument. Clearly, this needs to gain more visibility and ought to be included into clinical routine.

During Professor Xavier Jouven’s presentation on “What can we learn from the heart rate response during exercise and recovery?” it became clear how this simple and easy to use method is almost completely ignored and only receives attention in research lab, despite the fact that it has been convincingly shown to add to the diagnosis and assessment of the prognosis of patients not only with heart disease.

Last but not least, Professor Fraser very elegantly gave a convincing and strong “yes” as an answer to the question of “Is there a role for echocardiography during exercise testing”. Professor Fraser demonstrated how echocardiography does provide invaluable information of the functional assessment of the heart during exercise and in comparison to measurements obtained at rest. There is clearly a role for performing echocardiography during and/or immediately after CPX in order to get the full functional picture of the patient’s or athlete’s heart.

In summary, this session has nicely laid out how healthy persons and cardiac patients could all benefit from these well established methods, if they were used more often in the appropriate setting. Something that everyone in the audience can start doing the day they return from this excellent conference.




Exercise testing beyond the ST segment

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.