title: Cardiopulmonary exercise testing in patients with pulmonary hypertension: clinical recommendations based on a review of the evidence.
abstract: Pulmonary hypertension (PH) remains an ominous diagnosis despite advances in pharmacological and surgical therapy. Early and effective diagnosis is important for clinicians making treatment determinations and patients wishing to understand the prognostic implications of their illness. Cardiopulmonary exercise testing (CPX) has the power to reveal the underlying pathophysiological consequences of the disease process. Research, especially over the last 10-15 years, has demonstrated the utility of this tool. Several CPX variables have been shown to be consistently altered in patients with PH and more so as severity of disease increases. However, to further enhance clinical application, additional research is needed to better define optimal CPX measures and associated cutoff values. This paper gives class-based recommendations with associated levels of evidence for the use of CPX in the PH patient population.
authors.affiliation: a Department of Clinical & Applied Movement Sciences, Brooks College of Health , University of North Florida , Jacksonville , FL , USA.
authors.forename: Sherry O
authors.initials: SO
authors.lastname: Pinkstaff
authors.affiliation: b Division of Pulmonary and Critical Care Medicine , Mayo Clinic , Jacksonville , FL , USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Burger
authors.affiliation: c Department of Biomedical and Health Information Sciences, College of Applied Science , University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: John
authors.initials: J
authors.lastname: Daugherty
authors.affiliation: c Department of Biomedical and Health Information Sciences, College of Applied Science , University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Bond
authors.affiliation: d Department of Physical Therapy, Department of Kinesiology and Nutrition and Integrative Physiology Laboratory, College of Applied Health Sciences , University of Illinois Chicago at Chicago , Chicago , IL , USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
mesh_terms: D005080:Exercise Test; D017079:Exercise Tolerance; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: cardiopulmonary exercise testing; evidenced-based recommendations; minute ventilation/carbon dioxide production slope; oxygen consumption; partial pressure of end tidal carbon dioxide; pulmonary hypertension; ventilatory efficiency