The Role of Gas Analysis and Cardiopulmonary Exercise Testing

  • Vibhuti N. Singh
  • Ajoy Kumar
  • Joseph S. Janicki

Apart from the measurement of the vital signs, evaluation of exercise performance constitutes one of the most crucial parameters in the clinical assessment of a \nobreak patient. Many different methods are currently employed by the health care providers in this regard, but most remain un-standardized and arbitrary. Generally, physicians depend on the clinical history and the information provided by the patients about their own ability to walk a certain distance or climb a certain number of steps.


Pulmonary Arterial Hypertension Aerobic Capacity Anaerobic Threshold Incremental Exercise Right Atrial 
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  1. 1.
    Clark, AL, Poole-Wilson, PA, Coats, AJS. Effects of motivation of the patient on indices of exercise capacity in chronic heart failure. Br Heart J, 71:162–165, 1994.PubMedCrossRefGoogle Scholar
  2. 2.
    Holloszy, JO, Booth, FW. Biochemical adaptation to endurance exercise in muscle. Annu Rev Physiol, 38:273–291, 1976.PubMedCrossRefGoogle Scholar
  3. 3.
    Mitchell, JH, Bloomquist, CG. Maximal oxygen uptake. N Engl J Med, 284:1018–1022, 1971.PubMedGoogle Scholar
  4. 4.
    Saltin, B, Rowell, LB. Functional adaptation to physical activity and inactivity. Fed Proc, 39:1506–1513, 1980.PubMedGoogle Scholar
  5. 5.
    Weber, KT. Principles and applications of cardiopulmonary exercise testing. In Fishman, AP (ed.), Pulmonary Diseases and Disorders, 3rd ed. New York, McGraw Hill, 1998,pp. 575–588.Google Scholar
  6. 6.
    Taylor, HL, Buskirk, E, Henschel, A. Maximal O2 uptake as an objective measure of cardio-respiratory performance. J Applied Physiol, 8:73–80, 1955.Google Scholar
  7. 7.
    Mitchell, JH, Sproule, BJ, Chapman, CB. The physiological meaning of the maximal $O2$ intake test. J Clin Investigation, 37:538–547, 1958.CrossRefGoogle Scholar
  8. 8.
    Weber, KT, Janicki, JS. Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol, 55(Suppl A):22A–31A, 1985.PubMedCrossRefGoogle Scholar
  9. 9.
    Wasserman, K (ed.). Exercise Gas Exchange in Heart Disease. Armonk, NY, Futura, 1996.Google Scholar
  10. 10.
    Weber, KT, Janicki, JS (eds.). Cardiopulmonary Exercise Testing: Physiologic Principles and Clinical Applications. Philadelphia, Saunders, 1986.Google Scholar
  11. 11.
    Page, E, Cohen-Solal, A, Jondeau, G et al. Comparison of treadmill and bicycle exercise in patients with chronic heart failure. Chest, 106:1002–1006, 1994.PubMedCrossRefGoogle Scholar
  12. 12.
    Pollock, ML, Wilmore, JH, Fox, SM. Health and Fitness Through Physical Activity. New York, Wiley, 1978.Google Scholar
  13. 13.
    Weber, KT, Janicki, JS, McElroy, PA. Cardiopulmonary exercise (CPX) testing. In Weber KT, Janicki JS (eds.), Cardiopulmonary Exercise Testing: Physiologic Principles and Clinical Applications. Philadelphia, Saunders, 1986, pp. 151–167.Google Scholar
  14. 14.
    Janicki, JS. Influence of the pericardium and ventricular interdependence on left ventricular diastolic and systolic function in patients with heart failure. Circulation, 81:III-1500–III-20, 1990.Google Scholar
  15. 15.
    Janicki, JS, Weber, KT, Likoff, MJ, Fishman, AP. The pressure-flow response of the pulmonary circulation in patients with heart failure and pulmonary vascular disease. Circulation, 72:1270–1278, 1965.Google Scholar
  16. 16.
    Katz, LN, Feinberg, H, Shaffer, AB. Hemodynamic aspects of congestive heart failure. Circulation, 21:95–111, 1960.PubMedGoogle Scholar
  17. 17.
    Weber, KT, Janicki, JS. Lactate production during maximal and submaximal exercise in patients with chronic heart failure. J Am Coll Cardiol, 6:717–724, 1985.PubMedGoogle Scholar
  18. 18.
    Higginbotham, MB. Diastolic dysfunction and exercise gas exchange, In Wasserman, K (ed.), Exercise Gas Exchange in Heart Disease. Armonk, NY, Futura, 1996, pp. 39–54.Google Scholar
  19. 19.
    Kitzman, DW, Sheikh, KH, Beere, PA, et al. Age-related alterations of Doppler left ventricular filling indexes in normal subjects are independent of left ventricular mass, heart rate, contractility and loading conditions. J Am Coll Cardiol, 18:1243–1250, 1991.PubMedGoogle Scholar
  20. 20.
    Kao, AC, Van Trigt, P III, Shaeffer-McCall, GS, et al. Central and peripheral limitations to upright exercise in untrained cardiac transplant recipients. Circulation, 89:2605–2615, 1994.PubMedGoogle Scholar
  21. 21.
    Treese, N. Exercise gas exchange to evaluate cardiac pacemaker function. In Wasserman, K. (ed.), Exercise Gas Exchange in Heart Disease. Armonk, NY, Futura, 1996, pp. 257–270.Google Scholar
  22. 22.
    Donald, KW, Gloster, J, Harris, EA, et al. The production of lactic acid during exercise in normal subjects and in patients with rheumatic heart disease. A Heart J, 62:494–510, 1961.CrossRefGoogle Scholar
  23. 23.
    Gardner, AW, Montgomery, PS, Flinn, WR, Katzel, LI. The effect of exercise intensity on the response to exercise rehabilitation in patients with intermittent claudication. J Vasc Surg, 42:702–709, 2005.PubMedCrossRefGoogle Scholar
  24. 24.
    Dimopoulos, K, Okonko, DO, Diller, GP, et al. Abnormal ventilator response to exercise in adults with congenital heart disease relates to cyanosis and predicts survival. Circulation, 113:2796–2802, 2006.PubMedCrossRefGoogle Scholar
  25. 25.
    Gallagher, CG. Exercise limitation and clinical exercise stress testing in chronic obstructive pulmonary disease. Clin Chest Med, 15:305–326, 1994.PubMedGoogle Scholar
  26. 26.
    Marciniuk, DD, Gallagher, CG. Clinical exercise testing in interstitial lung disease. Clin Chest Med, 15:287–303, 1994.PubMedGoogle Scholar
  27. 27.
    Older, P, Smith, R, Courtney, P, et al. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest, 104:701–704, 1993.PubMedCrossRefGoogle Scholar
  28. 28.
    Mancini, DM, Eisen, H, Kussmaul, W, et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation, 83:778–786, 1991.PubMedGoogle Scholar
  29. 29.
    Stevenson, LW. Role of exercise testing in the evaluation of candidates for cardiac transplantation. In Wasserman, K (ed.), Exercise Gas Exchange in Heart Disease. Armonk, NY, Futura, 1996, pp. 271–286.Google Scholar
  30. 30.
    Mudge, GH, Goldstein, S, Addonizio, LJ, et al. 24th Bethesda conference: Cardiac transplantation. Task Force 3: Recipient guidelines/prioritization. J Am Coll Cardiol, 22:21–31, 1993.PubMedGoogle Scholar
  31. 31.
    Karvounis, HI, Dalamaga, EG, Papadopoulos, CE, et al. Improved papillary muscle function attenuates functional mitral regurgitation in patients with dilated cardiomyopathy after cardiac resynchronization. J Am Soc Echocardiogr, 19:1150–1157, 2006.PubMedCrossRefGoogle Scholar
  32. 32.
    Abraham, WT, Fisher, WG, Smith, AL, et al. Multicenter InSync Randomized Clinical Evaluation (MIRACLE). Cardiac resynchronization in chronic heart failure. N Engl J Med, 346:1845–1853, 2002.PubMedCrossRefGoogle Scholar
  33. 33.
    Paridon, SM, Alpert, BS, Boas, SR, et al. Clinical stress testing in the pediatric age group: A statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation, 113:1905–1920, 2006.PubMedCrossRefGoogle Scholar
  34. 34.
    Ekelund, LG, Haskell, WL, Johnson, JL, et al. Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men: The Lipid Research Clinics Mortality Follow-up Study. N Engl J Med, 319:1379–1384, 1988.PubMedCrossRefGoogle Scholar
  35. 35.
    Fleg, JL, Pina, IL, Balady, GJ, et al. Assessment of functional capacity in clinical and research applications: An advisory from the Committee on Exercise, Rehabilitation and Prevention, Council on Clinical Cardiology, American Heart Association. Circulation, 102:1591–1597, 2000.PubMedGoogle Scholar
  36. 36.
    Milani, RV, Lavie, CJ, Mehra, MR. Cardiopulmonary exercise testing, how do we differentiate the cause of dyspnea. Circulation, 110:e27–e31, 2004.PubMedCrossRefGoogle Scholar
  37. 37.
    Singh, VN. The role of gas analysis with exercise testing. Primary Care 28:159–179, 2001.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Vibhuti N. Singh
    • 1
  • Ajoy Kumar
    • 2
  • Joseph S. Janicki
    • 3
  1. 1.Department of Medicine, Division of CardiologyUniversity of South Florida College of Medicine; Clinical Research, Suncoast Cardiovascular CenterSt. PetersburgUSA
  2. 2.Family Practice Training Program, Bayfront Medical Center, St. PetersburgUSA
  3. 3.Department of Cell Biology and AnatomyUniversity of South Carolina School of MedicineColumbiaUSA

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