Lee Ingle

Prognostic value and diagnostic potential of cardiopulmonary exercise testing in patients with chronic heart failure

Cardiopulmonary exercise testing (CPET) is a well established technique for stratifying cardiovascular risk in patients with chronic heart failure (CHF). Important prognostic variables include a reduced peak oxygen uptake which has a central use in cardiac transplant selection, and the abnormal relation between minute ventilation (VE) and carbon dioxide production (VCO2), often referred to as the elevated VE/VCO2 slope. We will discuss the pathophysiology of these abnormal responses to exercise in CHF, and how these are interpreted during CPET. The potential of CPET for diagnosing circulatory, respiratory, metabolic, musculoskeletal or mixed limitations is an emerging field of research. We will speculate on how CHF manifests during CPET, and clarify the pathophysiological basis of these exercise responses. To improve our understanding of the diagnostic value of CPET, further investigation is required by clinicians to develop reference ranges for CHF patients from a co‐ordinated multicentre approach. The use of CPET technology is becoming increasingly prevalent in cardiology services, and it is likely that, in the future, CPET will take a more prominent role in guiding patient management provision.

Clinical determinants of poor six-minute walk test performance in patients with left ventricular systolic dysfunction and no major structural heart disease.

The clinical determinants of six‐minute walk test (6‐MWT) performance in patients with left ventricular systolic dysfunction (LVSD) have rarely been investigated, and it is not clear whether they differ from patients referred for the assessment of symptoms of heart failure who do not have major structural heart disease (MSHD).

Theoretical rationale and practical recommendations for cardiopulmonary exercise testing in patients with chronic heart failure

AbstractThe syndrome of chronic heart failure (CHF) becomes increasingly prevalent in older patients, and while mortality rates are declining in most cardiovascular diseases, both prevalence and mortality in CHF remain high. The heart is unable to meet the demands of the skeletal musculature, and symptoms manifest as dyspnoea and signs of fatigue during exercise. The cardiopulmonary exercise test (CPET) can provoke symptoms which may be useful in improving the accuracy of diagnosis in CHF in a non-invasive setting. CPET also provides important information on the pathophysiology of exercise limitation, risk stratification and can establish exercise-training protocols. The information provided by the CPET allows suitable pharmacological or device-based adjustments to be considered in the management of CHF, which can be crucial in maintaining a patient’s quality of life. This manuscript provides a useful insight into the theoretical rationale and practical recommendations for CPET in patients with CHF. Prior to CPET, it is important to consider the mode of exercise, as cycle ergometry or treadmill protocols will yield different outcomes in patients with CHF. We discuss how pre-CPET set-up procedures should be conducted and also the significance of electrocardiographic abnormalities found in CHF patients, and how these should be interpreted. The assessment of lung function is integral to the underlying pathophysiological basis of exercise limitation and we explain how this should be performed. CHF patients display the following abnormal exercise responses which can be identified by CPET: peak oxygen uptake (nn

Predicting peak oxygen uptake from 6-min walk test performance in male patients with left ventricular systolic dysfunction

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Impact of different diagnostic criteria on the prevalence and prognostic significance of exertional oscillatory ventilation in patients with chronic heart failure

peak), anaerobic threshold (AT), ΔVO2/Δ work rate (WR), peak oxygen pulse, estimated peak stroke volume and predicted peak heart rate are reduced. The nn

Derivation and validation of a simple clinical risk-model in heart failure based on 6 minute walk test performance and NT-proBNP status – Do we need specificity for sex and beta-blockers?

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