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Low cardiorespiratory fitness and exertional dyspnoea in a cancer patient

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

Rehabilitation and Sports Cardiology


The case

A 36-year-old male cancer patient (BMI 26.8 kg/m2) was assessed with a cardiopulmonary exercise test prior to his cardio-oncology rehabilitation programme:

  • He complained of exertional dyspnoea NYHA II.
  • He had a history of myelodysplastic syndrome, treated with chemotherapy (Cladribine, Idarubicin, and Cytarabine, followed by Decitabine) and an allogeneic stem cell transplantation.
  • He was in full remission.
  • His haemoglobin was 131 g/L.

Spirometry

 2019-11-case-CPX-Spirometry.JPG

9 Panel plot of the cardiopulmonary exercise test 

2019-11-case-CPX-9-PLOT.JPG

Key panles (2 and 5)

 2019-11-case-CPX-Key-Panels.JPG

 

Test findings

The resting spirometry showed a FVC (forced vital capacity) of 4.4 l (84% predicted), a FEV1 (forced expiratory volume) of 3.4 l (79% predicted), and a FEV1/FVC of 78%. Estimated maximum voluntary ventilation (MVV, FEV1*40) was 137 l/min.

Cardiorespiratory fitness was reduced with a peak VO2 of 20.5 ml/min/kg (58 % predicted) (Panel 3).

Blood pressure increased from 130/80 mmHg to 165/80 mmHg at peak exercise. Heart rate increased from 109 bpm to 173 bpm (94% of predicted) (Panel 2). Maximum respiratory exchange ratio was 1.23 (Panel 8). The patient was exhausted at the end of the test (Borg 19/20) and complained of exertional dyspnoea.

Maximum ventilation was 81 l (Panel 1). Breathing reserve ((1-VEmax/MVV)*100) was 41% (Panel 8). Respiratory efficiency, determined by the VE/VCO2 slope was 33 (Panel 4). The O2 pulse (VO2/heart rate) increased to 10.6 ml (59% of predicted, Panel 2). The VO2/work rate trajectory was 9.4 ml/min/watt (Panel 3).

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Note: The views and opinions expressed on this page are those of the author and may not be accepted by others. While every attempt is made to keep the information up to date, there is always going to be a lag in updating information. The reader is encouraged to read this in conjunction with appropriate ESC Guidelines. The material on this page is for educational purposes and is not for use as a definitive management strategy in the care of patients. Quiz material in the site are only examples and do not guarantee outcomes from formal examinations. 

References

Suggested reading:

Rozenbaum Z et al. Discriminating circulatory problems from deconditioning: Echocardiographic and cardiopulmonary exercise test analysis. Chest. 2017;151:431-440.