title: Protocol for exercise hemodynamic assessment: performing an invasive cardiopulmonary exercise test in clinical practice.
abstract: Invasive cardiopulmonary exercise testing (iCPET) combines full central hemodynamic assessment with continuous measurements of pulmonary gas exchange and ventilation to help in understanding the pathophysiology underpinning unexplained exertional intolerance. There is increasing evidence to support the use of iCPET as a key methodology for diagnosing heart failure with preserved ejection fraction and exercise-induced pulmonary hypertension as occult causes of exercise limitation, but there is little information available outlining the methodology to use this diagnostic test in clinical practice. To bridge this knowledge gap, the operational protocol for iCPET at our institution is discussed in detail. In turn, a standardized iCPET protocol may provide a common framework to describe the evolving understanding of mechanism(s) that limit exercise capacity and to facilitate research efforts to define novel treatments in these patients.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Natalia C
authors.initials: NC
authors.lastname: Berry
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Agarwal
authors.initials: A
authors.lastname: Manyoo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Oldham
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stephens
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Goldstein
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Waxman
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Tracy
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Leary
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Leopold
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston Massachusetts, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Kinlay
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Opotowsky
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Systrom
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston Massachusetts, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Maron
keywords: cardiopulmonary exercise testing; protocol; pulmonary hypertension