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    A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease: a primer for cardiologists.

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    Date
    2018-03
    Author
    Chaudhry, Sundeep
    Arena, Ross
    Bhatt, Deepak, L.
    Verma, Subodh
    Kumar, Naresh
    Publisher
    Lippincott, Williams & Wilkins
    Metadata
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    Abstract
    Purpose of review: There is growing clinical interest for the use of cardiopulmonary exercise testing (CPET) to evaluate patients with or suspected coronary artery disease (CAD). With mounting evidence, this concise review with relevant teaching cases helps to illustrate how to integrate CPET data into real world patient care. Recent findings: CPET provides a novel and purely physiological basis to identify cardiac dysfunction in symptomatic patients with both obstructive-CAD and nonobstructive-CAD (NO-CAD). In many cases, abnormal cardiac response on CPET may be the only objective evidence of potentially undertreated ischemic heart disease. When symptomatic patients have NO-CAD on coronary angiogram, they are still at increased risk for cardiovascular events. This problem appears to be more common in women than men and may warrant more aggressive risk factor modification. As the main intervention is lifestyle (diet, smoking cessation, exercise) and medical therapy (statins, angiotensin-converting enzyme inhibitors, beta-blockers), serial CPET testing enables close surveillance of cardiovascular function and is responsive to clinical status. Summary: CPET can enhance outpatient evaluation and management of CAD. Diagnostically, it can help to identify physiologically significant obstructive-CAD and NO-CAD in patients with normal routine cardiac testing. CPET may be of particular value in symptomatic women with NO-CAD. Prognostically, precise quantification of improvements in exercise capacity may help to improve long-term lifestyle and medication adherence for this chronic condition.
    Citation
    Chaudhry, S., Arena, R., Bhatt, D. L., Verma, S. and Kumar, N. A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease: A primer for cardiologists. Current Opinion in Cardiology. 2018. 33(2): 168-177. 10.1097/HCO.0000000000000494
    Subject
    Cardiopulmonary exercise testing
    Coronary artery disease
    Therapeutic monitoring
    Type
    Article
    Date available in INDIGO
    2018-06-25T19:21:32Z
    URI
    http://hdl.handle.net/10027/22423
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    • Publications - Physical Therapy

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