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Exercise Basic & Translational Research CPX Case

Dr. Matthias Wilhelm, Cardiopulmonary Exercise (CPX) Testing Quiz Section Editor



The case


This is the cardiopulmonary exercise testing (CPX) graphical (9-plot) report of an hypertensive patient (68 year old) with lone atrial fibrillation. CPX was performed before (blu symbols) and 20 days after external cardioversion (ECV) to sinus rythm (grey symbols).  

Before ECV he complained a mixed sensation of dyspnea/fatigue for moderate efforts and occasionally for daily life activities. Symptoms considerably improved post-ECV and the Borg scale (1 to 10) evaluation for effort-induced dyspnea quantification documented a score change from 8 before to 3 after ECV.
Pulmonary function tests (PFT) were performed at pre-ECV examination and documented a normal lung function: Forced Expiratory Capacity: 4,1 L (93% predicted); forced volume in 1 second: 3,9 L (92% predicted). PFT were not repeated after ECV.

The EKG showed a pre-ECV higher heart rate (HR) of 95 beats/min before compared to post ECV, 67 beats/min with excursion to 140 beats/min and 110 beats/min at peak exercise before and after ECV, respectively.

Test Findings

The 9-plot analysis documented 2 major findings to pick up, i.e ECV induced a remarkable improvement in VO2 max (plot # 3), likewise it was observed a significant improvement in VE (plot # 1) yielding to a better VE efficiency as signaled by a lower VE/VCO2 slope after ECV (plot # 4)



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Notes to editor

Prof. Marco Guazzi, FESC, Heart Failure Unit, Irccs San Donato Hosp.,University Of Milano

Dr. Matthias Wilhelm, MD, FESC, Dept. of Cardiology, University Hospital of Bern, Switzerland