2015 Fall Seminar Recap

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)

Copyright © 2004-2011; Metabolic Testing Services, Cor\p. USA.

1117 Perimeter Center West | Suite W-211 | Atlanta, Georgia 30338 | 678-636-3060

Sundeep Chaudhry, MDChief Medical Officer

Business: (678) 636-3062Mobile: (404) 966-1670Fax: (678) 636-3086E-mail: schaudhry@mettest.net

Website: www.mettest.net