2015 fall seminar recap
TRANSCRIPT
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Cardiopulmonary Exercise Testing (CPET)
Increasing Functional Capacity with
Physiology-Guided Therapy
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CPET Equipment
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*Balady et al. Clinician's Guide to Cardiopulmonary Exercise Testing in Adults. A Scientific Statement From the American Heart Association. Circulation. 2010;122:191-225.
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CPET fills Unmet Diagnostic Need
Detects invisible disorders
Microvascular Ischemia
Diastolic Heart Failure
Pulmonary Circulation Abnormalities
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Causes of Exercise Intolerance
303 Greensboro patients tested between June 2013 and Sept 2014
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Ischemic Heart Disease Progression
AtherosclerosisMicrovascular Ischemia
(endothelial dysfunction // ↓ coronary flow reserve)
Macrovascular Obstructive CAD(stress echo + nuclear stress test + coronary angiogram
+ coronary calcium score + carotid intimal thickness)
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Under-served Populations
Clinical Significance of Detecting Microvascular Ischemia
✓ Cardiac Prevention➢ Optimal Exercise Rx + Medical Therapy
✓ Chronic Angina Patients➢ Optimal Exercise Rx + Medical Therapy
✓ Women’s Heart Disease ➢ Optimal Exercise Rx + Medical Therapy
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Cardiorespiratory FitnessExercise Capacity
Functional Capacity
(1 MET = 3.5 ml 02/kg/min)
Normal =/> 85%
Mild: 70-84%
Moderate: 60-69%
Moderate to severe: 50-59%
Severe: < 49%
Peak VO2 = Prognosis !!
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Stroke volume (SV) → O2-pulse
Heart Rate (HR)
Peak VO2 =/> 100%• Good CV function (healthy)• Low resting sympathetic tone
Peak VO2 < 50%• Poor CV function (sick)• High resting sympathetic tone
• Atherosclerosis (CAD)• Cardiomyopathy (systolic & diastolic)• Valve Disease
Stroke Volume (SV)
Establish Baseline• Peak VO2 = 70%• Peak SV = 15
ml/beat• Peak HR = 150
Disease Progression (under treatment – intensify therapy)
Disease Regression (response to treatment -
adequate therapy)
over years
Cardiac Disease Spectrum & Tracking
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Baseline CPET
• Peak VO2 > 90%
• No LV Dysfunction
Low Risk
• Peak VO2 = 60-150%
• LV Dysfunction
Increased Risk
• Peak VO2 < 60%• LV Dysfunction
High Risk
• Continue current strategy
• Optimize diet/exercise
Treatment
• Intensify medical therapy
• Moderate Intensity Exercise Rx
• Consider coronary angiogram
Treatment
• Coronary angiogram
• Intensify medical therapy
• Moderate Intensity Exercise Rx
Treatment
CV Risk Stratification at Any Stage of Atherosclerosis
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Long Term Management Goals
Individualized VALIDATIONACC Goals for treatment of stable ischemic heart
disease
✓ Improve symptoms
✓ Increase Functional Capacity ❑ Peak VO2
❑ Peak SV (O2-pulse)
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