CONGRESS ABSTRACT

Cardio-pulmonary exercise testing (CPET) is a well-known method but still relatively little used by cardiologists, both quantitatively and qualitatively. In fact, this application has been mistakenly limited to the assessment of heart failure, usually by observing only the numerical parameter of “peak oxygen consumption (PeakVO2)”. The latter is used to quantify functional limitation in patients with chronic heart failure. Numerous parameters derived from cardiopulmonary exercise testing, if well collected and interpreted, prove extremely useful in the hands of the clinician. In particular, CPET is useful for revealing the origin (cardiac-pulmonary-muscular) of any functional limitation or revealing the origin of symptoms such as dyspnea and respiratory disorders and pulmonary hypertension (DIAGNOSTIC role). This is associated with valuable assistance in the prognostic stratification of the patient (PROGNOSTIC role), in particular: 1) a low peakVO2 value is associated with a worse prognosis. 2) Evidence of a peakVO2 value below 12 ml/kg/min identifies the patient as a possible candidate for transplantation. 3) Evidence of ventilatory inefficiency assessed by calculating the ventilation/CO2 production ratio slope (Ve/VCO2 slope; the normal value is generally less than 34) stratifies the prognosis (the higher the Ve/VCO2 slope value, the worse the prognosis). 4) The presence of oscillatory (or periodic) breathing during the active phase of exercise is an independent negative prognostic indicator. 5) The identification of the anaerobic threshold, the isocapnic buffering phase, and the respiratory compensation point (different phases of exercise) are essential in the assessment and correct prescription of physical exercise. 6) The peakVO2 and Ve/VCO2 slope parameters derived from CPET are included in the calculation of the risk of death or need for heart transplantation at two years in the recognized and appreciated MECKI score. CONCLUSIONS:The use of CPET is not particularly widespread in clinical practice, and the correct and apparently complex interpretation of the data and parameters collected often causes uncertainty and difficulty. Despite this, CPET remains a test that produces an accurate “snapshot” of all the components that determine the proper functioning of the body, and the identification of any abnormalities that cause reduced functional capacity is of great help to clinicians in terms of diagnosis,prognosis and treatment.