A description of the interpretation of the incremental cardiopulmonary exercise test

What is it about?

Textbooks and manuscripts have previously described the incremental cardiopulmonary exercise test in detail. In this review a focused, pathophysiology based approach has been suggested. Firstly, I suggest determining whether myocardial/circulatory insufficiency is present and second if there is gas exchange abnormality. By looking closely at the oxygen consumption versus work rate plot, one can see if oxygen delivery is adequate or if it is hampered by abnormally reduced blood flow through skeletal muscle (i.e., low cardiac output states). Additionally, elevated ventilatory equivalent of carbon dioxide at the ventilatory threshold and or arterial oxygen desaturation during effort, strongly suggest gas exchange abnormalities. Combining conclusions about these two processes facilitate understanding the source of exercise limitation.

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Why is it important?

The cardiopulmonary exercise test is becoming an increasingly used diagnostic modality for the purpose of evaluation of physical impairment in patients with cardiovascular and or respiratory impairments, for diagnostic and functional disability determination. A pathophysiologic approach that considers factors affecting adequacy of response of the cardiovascular and pulmonary systems to exercise, may facilitate understanding the mechanisms of such impairment in the individual patient.

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