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Value of cardiopulmonary exercise testing in the diagnosis of coronary artery disease
Berna Akıncı Özyürek1, Şerife Savaş Bozbaş2, Alp Aydınalp3
1Clinic of Chest Diseases, Ankara Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
Insights
Cardiopulmonary exercise testing (CPET) parameters like VE/VCO2 at anaerobic threshold and heart rate reserve may predict coronary artery disease (CAD). These CPET findings can aid in diagnosing CAD in patients with angina and dyspnea.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Cardiopulmonary exercise testing (CPET) offers comprehensive hemodynamic data during exercise, surpassing traditional treadmill tests.
- Evaluating respiratory and cardiac functions alongside skeletal and neurophysiologic systems is crucial for patient assessment.
Purpose of the Study:
- To investigate the correlation between CPET findings and coronary artery lesions identified via coronary angiography (CAG).
- To identify predictive CPET parameters for coronary artery disease (CAD) in patients experiencing angina pectoris.
Main Methods:
- Thirty patients with suspected CAD underwent treadmill exercise, CPET, and CAG.
- Key CPET parameters including oxygen consumption (VO2), minute ventilation (VE), and heart rate reserve (HRR) were analyzed.
- Significant CAD was defined as ≥50% narrowing in coronary arteries.
Main Results:
- CAD was detected in 59.4% of the study participants.
- Significant differences were observed in HRR, VE/VCO2 at anaerobic threshold (AT), and VO2 at AT between patients with and without CAD (p<0.05).
- While peak VO2 and O2 pulse were higher in patients without CAD, this difference was not statistically significant.
Conclusions:
- CPET parameters such as VE/VCO2 at AT, VO2 at AT, and HRR show potential predictive value for diagnosing CAD.
- These parameters may assist in evaluating patients with angina and dyspnea who are suspected of having CAD.
- CPET-derived metrics unaffected by patient effort can enhance its diagnostic utility for CAD.
Introduction:
Respiratory and cardiac functions in association with skeletal and neurophysiologic systems can be evaluated with cardiopulmonary exercise testing (CPET). Compared to treadmill exercise test, CPET provides more comprehensive data about the hemodynamic response to exercise.
Materials And Methods:
We aimed to evaluate the relationship with CPET findings and coronary lesions identified on angiography in patients with angina pectoris who underwent teradmill exercise, CPET and coronary angiography (CAG). By this way we sought to examine the CPET parameters that might be predictive for coronary artery disease (CAD) before diagnostic exercise test results and ischemia symptoms develop. Thirty patients in whom CAG was planned because of symptoms and exercise test results were enrolled in the study. Oxygen consumption (VO2), carbondioxide production (VCO2), minute ventilation (VE), maximum work rate (WR), DVO2/DWR and O2 pulse (VO2/HR) values were calculated. Significant CAD was defined as ≥ 50% narrowing in at least one of the coronary arteries.
Result:
The mean age was 60.4 ± 8.9 years ve 21 (65.6%) of subjects were male. On CAG, CAD was detected in 19 (59.4%) patients. Maximum heart rate, heart rate reserve (HRR), VE/VCO2 measured at anaerobic threshold (AT) and VO2(mL/kg/min) were significantly differed in patients with CAD than those without (p= 0.031; p= 0.041; p= 0.028; p= 0.03 respectively). Peak VO2, VO2/WR and O2 pulse values were higher in patients with normal angiographic results than those with CAD but the difference did not reach to statistical significance.
Conclusions:
The findings of our study indicate that among CPET parameters AT VE/VCO2, ATVO2 (mL/kg/dk) and HRR can have predictive value in the diagnosis of CAD. We think that these parameters might be used in the evaluation of patients with angina and dyspnea suspected of CAD. In conclusion parameters obtained during the test that are not influenced by patient's effort might increase the value of CPET in the diagnosis CAD.
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