2015 fall seminar recap
TRANSCRIPT
Cardiopulmonary Exercise Testing (CPET)
Increasing Functional Capacity with
Physiology-Guided Therapy
CPET Equipment
*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.
CPET fills Unmet Diagnostic Need
Detects invisible disorders
Microvascular Ischemia
Diastolic Heart Failure
Pulmonary Circulation Abnormalities
Causes of Exercise Intolerance
303 Greensboro patients tested between June 2013 and Sept 2014
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)
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
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 !!
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
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
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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Sundeep Chaudhry, MDChief Medical Officer
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