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The impact of combined cardiopulmonary exercise testing and SPECT myocardial perfusion imaging on downstream evaluation and management

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

The diagnostic yield of combined cardiopulmonary exercise testing (CPET) and myocardial perfusion imaging (MPI) in patients referred for stress testing has received limited study.

Methods

We evaluated consecutive patients who underwent combined CPET-MPI at a single tertiary referral center between 2011 and 2015. An abnormal CPET was defined as any of the following: reduced oxygen consumption, cardiac output impairment, or pulmonary impairment. Normal MPI was defined as the absence of resting or stress perfusion defect. The primary study outcome was change in clinical decision-making after CPET-MPI including management of pulmonary disease, management of deconditioning, heart failure management, and referral for cardiac catheterization. Outcomes of patients with normal and abnormal MPI were presented based on the specific CPET abnormality.

Results

415 patients were included in the study. Of the 269 patients that had normal MPI, 206 (77%) had abnormal CPET. Patients with abnormal CPET and normal MPI, compared with patients that had normal CPET and normal MPI, were more frequently diagnosed with pulmonary disease (11.7% vs 3.2%, P = .04) and deconditioning (33.5% vs 17.4%, P = .01). Of the 146 patients that had abnormal MPI, 128 (88%) had abnormal CPET. Patients with abnormal CPET and abnormal MPI, compared with patients that had normal CPET and abnormal MPI, did not statistically differ with regard to the study outcome.

Conclusion

An abnormal CPET, if the MPI was normal, prompted further evaluation and led to management of pulmonary disease and deconditioning.

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Abbreviations

CPET:

Cardiopulmonary exercise testing

MPI:

Myocardial perfusion imaging

SPECT:

Single-photon emission computed tomography

MET:

Metabolic equivalents

FAC:

Functional aerobic capacity

VO2 :

Oxygen consumption

VE:

Minute ventilation

VCO2 :

Carbon dioxide production

RER:

Respiratory exchange ratio

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Disclosure

All authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Georgios Christopoulos MD

  2. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    John Bois MD, Thomas G. Allison PhD, Martin Rodriguez-Porcel MD & Panithaya Chareonthaitawee MD

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  1. Georgios Christopoulos MD
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  2. John Bois MD
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  3. Thomas G. Allison PhD
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  5. Panithaya Chareonthaitawee MD
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Correspondence to Panithaya Chareonthaitawee MD.

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Christopoulos, G., Bois, J., Allison, T.G. et al. The impact of combined cardiopulmonary exercise testing and SPECT myocardial perfusion imaging on downstream evaluation and management. J. Nucl. Cardiol. 26, 92–106 (2019). https://doi.org/10.1007/s12350-017-0910-3

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  • DOI: https://doi.org/10.1007/s12350-017-0910-3

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