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Cardiopulmonary exercise stress test in bundle branch block (LBBB)

Cardiac Rehabilitation CPX Study Case


A 55 year-old man with chest pain of unknown origin was referred for an exercise stress echo, but the results were uninterpretable for abnormal movement of the interventricular septum. The patient agreed to participate in a study protocol on CPET in LBBB. Oxygen uptake and O2pulse kinetics during exercise reflect cardiac output and stroke volume, respectively, which are flattened  when myocardial ischemia develops. As a result, CPET may be used to detect/exclude inducible myocardial ischemia when ECG is uninterpretable.



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For further reading:

[*1] Exercise-induced myocardial sichemia detected by cardiopulmonary exercise testing.
Belardinelli R, Lacalaprice F, Carle F, et al.  
Eur Heart J 2003;24:1304-1313.
[*2] Cardiopulmonary exercise testing is more accurate than ECG-stress testing in diagnosing myocardial ischemia in subjects with chest pain.
Belardinelli R,  Lacalaprice F, Tiano L, et al.
Int J Cardiol 2014; 174(2):337-42
[*3] Exercise-induced myocardial ischemia detected by cardiopulmonary exercise testing.
Chaudhry S, Arena R, Wasserman K, Hansen JE, Lewis GD, Myers J, Chronos N, Boden WE.
Am J Cardiol. 2009;103:615-9.
4_ Detecting abnormalities in left ventricular function during exercise before angina and ST segment depression.
Upton MT, Rerych SK, Newman GE, Port S, Cobb FR, Jones RH.
Circulation 1980;62:341-9.