Exercise Testing – clinical utility Sudhir Rao Respiratory registrar

CPET is the gold standard For an objective measure of exercise capacity To identify the mechanisms limiting exercise tolerance To establish indices of the patient’s prognosis Evaluate the effects of therapeutic interventions

Aim To discuss the role of exercise testing in evaluating prognosis in patients with chronic Lung & Heart disease

Common prognostic indicator FEV1 – Cystic Fibrosis(CF), COPD DLCO – ILD, PPH PaO2, PaCO2- COPD, CF, PPH BMI- CF, COPD,PPH Dyspnea- COPD, PF EF, NYHA - CCF

Survival rate and NYHA classes

FEV1 and prognosis in COPD AJRCCM 2003; 167:

Exercise variables/indexes that have a high prognostic value in patients with chronic pulmonary & cardiac diseases V’O2 peak- COPD, CF, PPH, CCF V’O2 at LT(Lactate Threshold)- CCF V’ E /V’CO2 slope at LT- CCF Arterial O2 desaturation- ILD, CF Dyspnea- COPD,PF 6MWT distance- CCF,CF,COPD,PH

V’O2 at rest and during exercise

V’O2- Work rate relationship ~ 10 ml V’O2/min/watt

V’O2 peak and prognosis in CCF Time (months) Peak V’O2 (ml/kg/min)

Kaplan-Meier life-table analysis for V’O2 max > 45% vs < 45% predicted Kleber FX, Circulation 2000

In COPD, V’O2 peak predicts mortality independently of FEV1 Oga T, AJRCCM 2003

Assessment of Survival in Patients with PPH: Importance of CPET Circulation 2002; 106: