Cardio Pulmonary Exercise Test

1

Dr. Amir Hosein Abedi Yekta

Sport & Exercise Medicine

PHYSIOLOGY OF EXERCISE

• Peak exercise capacity is defined as ‘‘the maximum ability of the cardiovascular system to deliver oxygen to exercising skeletal muscle and of the exercising muscle to extract oxygen from the blood’’.

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PHYSIOLOGY OF EXERCISE

• Peak exercise capacity is defined as ‘‘the maximum ability of the cardiovascular system to deliver oxygen to exercising skeletal muscle and of the exercising muscle to extract oxygen from the blood’’.

3

• exercise tolerance is determined by three factors:

pulmonary gas exchange

cardiovascular performance, including the peripheral vascular tree

skeletal muscle metabolism

4

The Fick equation

• VO2 = (SV ×HR) ×(aO2 - vO2)

• peak VO2 (PVO2) is often used as an estimate of VO2max

5

Exercise intolerance(functional aerobic impairment)

• maximal heart rate

• maximal stroke volume

• maximal CaO2

• rest CvO2

6

• The cardiac output may be relatively normal at rest, but usually does not increase adequately with even mild exertion.

7

8

Consumption Air

Measurement

What is CPET?

Wasserman Plots

• Parameters in the Wasserman-Plots

• Oxygen uptake V‘O2

• Carbon dioxide output V‘CO2

• Respiratory Exchange Rate R (RER, RQ, R)

• Ventilation VT and BF

• Minute Ventilation (V‘E)

• Heart Rate HR

• Endtidal partial pressure PetO2, PetCO2

99

9-Panel Plots

10

• CPET has an important role in the diagnosis, quantification of symptoms, prognosis and assessment of the success of therapeutic interventions in patients with HF

• CPET is often helpful for classifying disease severity for treatment decisions and in the differential diagnosis of exercise intolerance and symptoms of dyspnea and fatigue

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VT1 (vAT)

The Ventilatory Threshold 1

1212

VT1

Work Rate

O2-Uptake

CO2-Output

Ventilation

13

Time

13

VT1

14

Wasserman 5

α

14

VT1

Wasserman 6

1515

Wasserman 9

16

VT1

16

VT1

Excess-CO2-Method

1717

The Ventilation – for verfivication useV

en

tila

tio

n

18

VT1

Time / Load

Wassermann 1

beginning of load phase

VT2 / RCP

VT1 / VAT

18

Wasserman 1

19

VT1

Beginning of load phase

VT2 / RCP

VT1 / VAT

19

VT1

• Result:

• There are 4 (5) different methods to calculate or evaluate the ventilatory

Anaerobic Threshold (v)AT:

- V-Slope Wasserman 5, (45o-line Wasserman 5)

- Equivalent-Method Wasserman 6

- Endtidal Partialpressure O2 in Wasserman 9

- Excess-CO2-Method

- Validation Ventilation V‘E (Wasserman 1)

RER=1 is not a threshold!!!

2020

RCP (VT2)

RCP (VT2)Respiraory Compensation Point

2121

RCP (VT2)

Ventilation

22

CO2-Output

H+

H+

H+H+

H+H+

Lactate

Time / Load

buffer system

Load

22

RCP (VT2)

Slope-Method

2323

RCP (VT2)

24

Wasserman 4

24

RCP (VT2)

Equivalent-Method

2525

RCP (VT2)

CO2-Output

Ventilation

V‘E

V‘CO2

2626

RCP (VT2)

Wasserman 6

2727

RCP (VT2)

PetCO2-Method

28

End-tidal partial

pressure CO2

28

RCP (VT2)

End-tidal partial pressure CO2

29

Time or Load

CO2-output

Ventilation

29

RCP (VT2)

End-tidal partial pressure CO2

30

• Overproportional increase of V‘E (BF) with

constant increase of CO2-output

• „amount “ (partial pressure) of CO2 / BF

decreases

• This is beeing measured endtidally (last

200ms / breath)

30

RCP (VT2)

Wasserman 9

3131