In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

66 year-old male with exertional dyspnoea

Cardiopulmonary Exercise Testing - February 2015



Case description

  • This male patient (66 years, BMI 25 kg/m2, current smoker) has a history of bilateral pulmonary embolism in June 2013 which was treated with EKOS-lysis (ultrasound-enhanced thrombolysis). He is currently under oral anticoagulation.
  • During work-up, coronary artery disease (CAD) with a high-degree right coronary artery stenosis was detected. A percutaneous coronary intervention (PCI) was performed in July 2013. Left ventricular ejection fraction was slightly reduced (50%).
  • This is the cardiopulmonary exercise testing (CPX) 9 panel plot at the beginning of a 3-month ambulatory cardiac rehabilitation program. The patient complained of persisting exertional dyspnoe NYHA III, but no chest pain, dizziness or syncope.
  • Pulmonary function test (PFT) was performed: Forced Vital Capacity (FVC): 3.0 L (71% predicted); Forced Expiratory Volume in 1 second (FEV1): 2.6 L (79% predicted). FEV1/FVC ratio 85%.


Test findings

  • The 9-plot analysis documented a reduced exercise capacity with 81 Watt (51% predicted), and a peak VO2 of 1130 ml/min, 14.0 ml/min/kg (55% predicted) (Panel 3).
  • The O2 pulse (VO2/heart rate) (Panel 2) and the VO2/work rate slope (Panel 3) were reduced.
  • The VE/VCO2 slope was markedly elevated with a value of 50 (Panel 4).
  • Breathing reserve (1- ratio  of ventilation at maximal exercise to maximal voluntary ventilation) was 0.18 (Panel 8).
  • PETCO2 was low at rest (23 mmHg) and did not increase during exercise (Panel 9).
  • Blood pressure was 115/70 mmHg at rest and 120/80 mmHg at maximum exercise. SpO2 was not recorded due to a technical problem. Exercise ECG revealed no exercise-induced ischemia.



Test your knowledge


Suggested readings:
Exercise pathophysiology in patients with primary pulmonary hypertension
Sun XG, Hansen JE, Oudiz RJ, Wasserman K.
Circulation. 2001;104(4):429-35.

EACPR/AHA Joint Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations.
Guazzi M, Adams V, Conraads V, et al.
Eur Heart J. 2012;33(23):2917-27.

Of interest:
Other Cardiopulmonary Exercise Testing cases