Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations

European Heart Journal

Volumn 33, Issue 23, 2012, Pages 2917-2927

  Guazzi, Marco ^a   Adams, Volker ^b   Conraads, Viviane ^c   Halle, Martin ^d   Mezzani, Alessandro ^e   Vanhees, Luc ^f   Arena, Ross ^g   Fletcher, Gerald F ^h   Forman, Daniel E ⁱ   Kitzman, Dalane W ^j   Lavie, Carl J ^k,l   Myers, Jonathan ^m  

^a UNIVERSITY OF MILAN   (Italy)

^b UNIVERSITY OF LEIPZIG HEART CENTER   (Germany)

^c ANTWERP UNIVERSITY HOSPITAL   (Belgium)

^d TECHNICAL UNIVERSITY OF MUNICH   (Germany)

^e IRCCS   (Italy)

^f KU LEUVEN DEPARTMENT OF REHABILITATION SCIENCES   (Belgium)

^g UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE   (United States)

^h MAYO CLINIC   (United States)

ⁱ BRIGHAM AND WOMEN S HOSPITAL   (United States)

^j WAKE FOREST SCHOOL OF MEDICINE   (United States)

^k UNIVERSITY OF QUEENSLAND   (Australia)

^l PENNINGTON BIOMEDICAL RESEARCH CENTER   (United States)

^m STANFORD UNIVERSITY   (United States)

more..

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; AWARENESS; CARDIOPULMONARY EXERCISE TEST; CHRONIC OBSTRUCTIVE LUNG DISEASE; CLINICAL ASSESSMENT; CLINICAL PRACTICE; CONGENITAL HEART DISEASE; DYSPNEA; HEALTH CARE PERSONNEL; HEART EJECTION FRACTION; HEART MUSCLE ISCHEMIA; HUMAN; HYPERTROPHIC CARDIOMYOPATHY; INTERSTITIAL LUNG DISEASE; MITOCHONDRIAL MYOPATHY; PATIENT CARE; PATIENT REFERRAL; PRACTICE GUIDELINE; PRIORITY JOURNAL; PULMONARY HYPERTENSION; SYSTOLIC HEART FAILURE; CARDIOMYOPATHY; CLASSIFICATION; COMPUTER PROGRAM; EXERCISE TEST; FORECASTING; HEART DISEASE; INFORMATION PROCESSING; LUNG FUNCTION TEST; METHODOLOGY; OXYGEN CONSUMPTION; PATHOPHYSIOLOGY; PATIENT; PROGNOSIS; RESPIRATORY TRACT DISEASE; STANDARD; STATISTICS;

CARDIOMYOPATHIES; EXERCISE TEST; FORECASTING; HEART DISEASES; HUMANS; MITOCHONDRIAL MYOPATHIES; OXYGEN CONSUMPTION; PATIENTS; PROGNOSIS; RECORDS AS TOPIC; RESPIRATORY FUNCTION TESTS; RESPIRATORY TRACT DISEASES; SOFTWARE;

EID: 84870852991     PISSN: 0195668X     EISSN: 15229645     Source Type: Journal    
DOI: 10.1093/eurheartj/ehs221     Document Type: Article

References (107)

1. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, Forman D, Franklin B, Guazzi M, Gulati M, Keteyian SJ, Lavie CJ, Macko R, Mancini D, Milani RV. Clinician's guide to cardiopulmonary exercise testing in adults. A scientific statement from the American Heart Association. Circulation 2010;122: 191-225.
2. Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, Vanhees L. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part II: How to perform cardiopulmonary exercise testing in chronic heart failure. Eur J Cardiovasc Prev Rehabil 2006;13:300-311.
3. Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, Vanhees L. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part I: definition of cardiopulmonary exercise testing parameters for appropriate use in chronic heart failure. Eur J Cardiovasc Prev Rehabil 2006;13:150-164.
4. Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, Vanhees L. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part III: Interpretation of cardiopulmonary exercise testing in chronic heart failure and future applications. Eur J Cardiovasc Prev Rehabil 2006;13:485-494.
5. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211-277.
6. Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD Jr, Winters WL, Yanowitz FG, Ritchie JL, Gibbons RJ, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Lewis RP, O'Rourke RA, Ryan TJ. ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997;30:260-311.
7. Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail Rev 2008;13:245-269.
8. Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant 2010;29:159-173.
9. Mezzani A, Agostoni P, Cohen-Solal A, Corrà U, Jegier A, Kouidi E, Mazic S, Meurin P, Piepoli M, Simon A, Laethem CV, Vanhees L. Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2009;16:249-267.
10. Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, O'Donnell DE, Puente-Maestu L, Schols AM, Singh S, Whipp BJ. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007;29: 185-209.
11. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, Collins E, Fletcher G. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 2007;116:329-343.
12. Brunelli A, Belardinelli R, Refai M, Salati M, Socci L, Pompili C, Sabbatini A. Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection. Chest 2009;135:1260-1267.
13. Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, Guazzi M. Development of a ventilatory classification system in patients with heart failure. Circulation 2007;115:2410-2417.
14. Abidov A, Rozanski A, Hachamovitch R, Hayes SW, Aboul-Enein F, Cohen I, Friedman JD, Germano G, Berman DS. Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med 2005;353:1889-1898.
15. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14:377-381.
16. Corra U, Giordano A, Bosimini E, Mezzani A, Piepoli M, Coats AJ, Giannuzzi P. Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest 2002;121:1572-1580.
17. Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, Balady GJ. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation 2009;119:3144-3161.
18. Chase P, Arena R, Myers J, Abella J, Peberdy MA, Guazzi M, Kenjale A, Bensimhon D. Prognostic usefulness of dyspnea versus fatigue as reason for exercise test termination in patients with heart failure. Am J Cardiol 2008;102: 879-882.
19. Pinkstaff S, Peberdy MA, Kontos MC, Finucane S, Arena R. Quantifying exertion level during exercise stress testing using percentage of age-predicted maximal heart rate, rate pressure product, and perceived exertion. Mayo Clin Proc 2010;85:1095-1100.
20. Jain M, Nkonde C, Lin B, Walker A, Wackers F. 85% of maximal age-predicted heart rate is not a valid endpoint for exercise treadmill testing. J Nucl Cardiol 2011;18:1026-1035.
21. Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 2011;123:668-680.
22. Taivassalo T, Dysgaard Jensen T, Kennaway N, DiMauro S, Vissing J, Haller RG. The spectrum of exercise tolerance in mitochondrial myopathies: a study of 40 patients. Brain 2003;126:413-423.
23. Campbell SC. A comparison of the maximum voluntary ventilation with the forced expiratory volume in one second: an assessment of subject cooperation. J Occup Med 1982;24:531-533.
24. Wasserman K, Hansen JE, Sue DY, Whipp BJ. Principles of Exercise Testing and Interpretation, 4th ed. Philadelphia: Lea and Febiger; 2005.
25. Ingle L, Isted A, Witte KK, Cleland JGF, Clark AL. Impact of different diagnostic criteria on the prevalence and prognostic significance of exertional oscillatory ventilation in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2009;16:451-456.
26. Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis 1984;129:S49-S55.
27. Wasserman K, Hansen JE, Sue DY, Stringer W, Whipp BJ. Normal Values. In: Weinberg R (ed.). Principles of Exercise Testing and Interpretation, 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p160-182.
28. Arena R, Myers J, Guazzi M. The clinical significance of aerobic exercise testing and prescription: from apparently healthy to confirmed cardiovascular disease. Am J Lifestyle Med 2008;2:519-536.
29. Arena R, Myers J, Guazzi M. The future of aerobic exercise testing in clinical practice: is it the ultimate vital sign? Future Cardiol 2010;6:325-342.
30. Weber KT, Janicki JS, McElroy PA. Determination of aerobic capacity and the severity of chronic cardiac and circulatory failure. Circulation 1987;76:VI40-VI45.
31. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991;83:778-786.
32. Poggio R, Arazi HC, Giorgi M, Miriuka SG. Prediction of severe cardiovascular events by VE/VCO2 slope versus peak VO2 in systolic heart failure: a meta-analysis of the published literature. Am Heart J 2010;160:1004-1014.
33. Corra U, Piepoli MF. Official document on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction- recommendations for performance and interpretation. Monaldi Arch Chest Dis 2007;68:6-12.
34. Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Forman DE, Guazzi M. Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure. Circ Heart Fail 2010;3:405-411.
35. Guazzi M, Arena R, Ascione A, Piepoli M, Guazzi MD. Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value. Am Heart J 2007;153:859-867.
36. Arena R, Guazzi M, Myers J. Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure. Int J Cardiol 2007;117:103-108.
37. Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Guazzi M. The partial pressure of resting end-tidal carbon dioxide predicts major cardiac events in patients with systolic heart failure. Am Heart J 2008;156:982-988.
38. Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Forman D,West E, Guazzi M. Determining the preferred per cent-predicted equation for peak oxygen consumption in patients with heart failure. Circ Heart Fail 2009;2:113-120.
39. Osada N, Chaitman BR, Miller LW, Yip D, Cishek MB,Wolford TL, Donohue TJ. Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation [see comments]. J Am Coll Cardiol 1998;31:577-582.
40. Stelken AM, Younis LT, Jennison SH, Miller DD, Miller LW, Shaw LJ, Kargl D, Chaitman BR. Prognostic value of cardiopulmonary exercise testing using percent achieved of predicted peak oxygen uptake for patients with ischemic and dilated cardiomyopathy. J Am Coll Cardiol 1996;27:345-352.
41. Simon MA, Kormos RL, Gorcsan J III, Dohi K, Winowich S, Stanford E, Carozza L, Murali S. Differential exercise performance on ventricular assist device support. J Heart Lung Transplant 2005;24:1506-1512.
42. Guazzi M, Arena R. The impact of pharmacotherapy on the cardiopulmonary exercise test response in patients with heart failure: a mini review. Curr Vasc Pharmacol 2009;7:557-569.
43. Wasserman K, Sun XG, Hansen JE. Effect of biventricular pacing on the exercise pathophysiology of heart failure. Chest 2007;132:250-61.
44. Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, Guazzi M. The prognostic value of the heart rate response during exercise and recovery in patients with heart failure: influence of beta-blockade. Int J Cardiol 2010;138: 166-173.
45. Bilsel T, Terzi S, Akbulut T, Sayar N, Hobikoglu G, Yesilcimen K. Abnormal heart rate recovery immediately after cardiopulmonary exercise testing in heart failure patients. Int Heart J 2006;47:431-440.
46. Guazzi M, Myers J, Arena R. Cardiopulmonary exercise testing in the clinical and prognostic assessment of diastolic heart failure. J Am Coll Cardiol 2005;46: 1883-1890.
47. Guazzi M, Myers J, Peberdy MA, Bensimhon D, Chase P, Arena R. Cardiopulmonary exercise testing variables reflect the degree of diastolic dysfunction in patients with heart failure-normal ejection fraction. J Cardiopulm Rehabil Prev 2010;30:165-172.
48. Guazzi M, Myers J, Peberdy MA, Bensimhon D, Chase P, Arena R. Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights. Eur Heart J 2008;29:2751-2759.
49. Dimopoulos K, Okonko DO, Diller GP, Broberg CS, Salukhe TV, Babu-Narayan SV, Li W, Uebing A, Bayne S, Wensel R, Piepoli MF, Poole-Wilson PA, Francis DP, Gatzoulis MA. Abnormal ventilatory response to exercise in adults with congenital heart disease relates to cyanosis and predicts survival. Circulation 2006;113:2796-2802.
50. Inuzuka R, Diller GP, Borgia F, Benson L, Tay EL, Alonso-Gonzalez R, Silva M, Charalambides M, Swan L, Dimopoulos K, Gatzoulis MA. Comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term/clinical perspective. Circulation 2012;125:250-259.
51. Giardini A, Hager A, Lammers AE, Derrick G, Müller J, Diller GP, Dimopoulos K, Odendaal D, Gargiulo G, Picchio FM, Gatzoulis MA. Ventilatory efficiency and aerobic capacity predict event-free survival in adults with atrial repair for complete transposition of the great arteries. J Am Coll Cardiol 2009;53:1548-1555.
52. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O'Reilly MG, Winters WL, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, Smith SC. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002;40: 1531-1540.
53. Sharma S, Firoozi S, McKenna WJ. Value of exercise testing in assessing clinical state and prognosis in hypertrophic cardiomyopathy. Cardiol Rev 2001;9:70-76.
54. Bunch TJ, Chandrasekaran K, Ehrsam JE, Hammill SC, Urban LH, Hodge DO, Ommen SR, Pellikka PA. Prognostic significance of exercise induced arrhythmias and echocardiographic variables in hypertrophic cardiomyopathy. Am J Cardiol 2007;99:835-838.
55. Drinko JK, Nash PJ, Lever HM, Asher CR. Safety of stress testing in patients with hypertrophic cardiomyopathy. Am J Cardiol 2004;93:1443-144, A12.
56. Sharma S, Elliott PM, Whyte G, Mahon N, Virdee MS, Mist B, McKenna WJ. Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes. J Am Coll Cardiol 2000;36:864-870.
57. Arena R, Owens DS, Arevalo J, Smith K, Mohiddin SA, McAreavey D, Ulisney KL, Tripodi D, Fananapazir L, Plehn JF. Ventilatory efficiency and resting hemodynamics in hypertrophic cardiomyopathy. Med Sci Sports Exerc 2008;40: 799-805.
58. Sorajja P, Allison T, Hayes C, Nishimura RA, Lam CSP, Ommen SR. Prognostic utility of metabolic exercise testing in minimally symptomatic patients with obstructive hypertrophic cardiomyopathy. Am J Cardiol 2012;109:1494-1498.
59. Morise AP. Exercise testing in nonatherosclerotic heart disease: hypertrophic cardiomyopathy, valvular heart disease, and arrhythmias. Circulation 2011;123: 216-225.
60. Elliott PM, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A, Mahon NG, McKenna WJ. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 2000;36:2212-2218.
61. Ciampi Q, Betocchi S, Losi MA, Ferro A, Cuocolo A, Lombardi R, Villari B, Chiariello M. Abnormal blood-pressure response to exercise and oxygen consumption in patients with hypertrophic cardiomyopathy. J Nucl Cardiol 2007; 14:869-875.
62. Gimeno JR, Tome-Esteban M, Lofiego C, Hurtado J, Pantazis A, Mist B, Lambiase P, McKenna WJ, Elliott PM. Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy. Eur Heart J 2009;30:2599-2605.
63. Clark MV. Defining asthma. In: Gartside M (ed.) Asthma: A Clinician's Guide. Sudbury: Jones and Bartlett Learning; 2011. p15-34.
64. Kukafka DS, Lang DM, Porter S, Rogers J, Ciccolella D, Polansky M, D'Alonzo GE Jr. Exercise-induced bronchospasm in high school athletes via a free running test. Chest 1998;114:1613-1622.
65. Rundell KW, Wilber RL, Szmedra L, Jenkinson DM, Mayers LB, Im J. Exercise-induced asthma screening of elite athletes: field versus laboratory exercise challenge. Med Sci Sports Exerc 2000;32:309-316.
66. Rundell KW, Jenkinson DM. Exercise-induced bronchospasm in the elite athlete. Sports Med 2002;32:583-600.
67. ERS Task Force on Standardization of Clinical Exercise Testing. European Respiratory Society. Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur Respir J 1997;10: 2662-2689.
68. Yasunobu Y, Oudiz RJ, Sun XG, Hansen JE, Wasserman K. End-tidal PCO2 abnormality and exercise limitation in patients with primary pulmonary hypertension. Chest 2005;127:1637-1646.
69. Dumitrescu D, Oudiz RJ, Karpouzas G, Hovanesyan A, Jayasinghe A, Hansen JE, Rosenkranz S, Wasserman K. Developing pulmonary vasculopathy in systemic sclerosis, detected with non-invasive cardiopulmonary exercise testing. PLoS One 2010;5:e14293.
70. Borlaug BA, Nishimura RA, Sorajja P, Lam CS, Redfield MM. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 2010;3:588-95.
71. Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 2011;32:670-679.
72. Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant 2010;29:159-173.
73. Arena R. Detecting abnormal pulmonary hemodynamics with cardiopulmonary exercise testing. Med Sci Sports Exerc 2011;43:982.
74. Arena R. Exercise testing and training in chronic lung disease and pulmonary arterial hypertension. Prog Cardiovasc Dis 2011;53:454-463.
75. Arena R, Guazzi M, Myers J, Grinnen D, Forman DE, Lavie CJ. Cardiopulmonary exercise testing in the assessment of pulmonary hypertension. Expert Rev Respir Med 2011;5:281-293.
76. Hansen JE, Sun XG, Yasunobu Y, Garafano RP, Gates G, Barst RJ, Wasserman K. Reproducibility of cardiopulmonary exercise measurements in patients with pulmonary arterial hypertension. Chest 2004;126:816-824.
77. Hansen JE, Ulubay G, Chow BF, Sun XG, Wasserman K. Mixed-expired and endtidal CO2 distinguish between ventilation and perfusion defects during exercise testing in patients with lung and heart diseases. Chest 2007;132:977-983.
78. Oudiz RJ, Roveran G, Hansen JE, Sun XG, Wasserman K. Effect of sildenafil on ventilatory efficiency and exercise tolerance in pulmonary hypertension. Eur J Heart Fail 2007;9:917-921.
79. Sun X, Hansen JE, Oudiz RJ, Wasserman K. gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension. Circulation 2002;105:54-60.
80. Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation 2001;104:429-435.
81. Ting H, Sun XG, Chuang ML, Lewis DA, Hansen JE,Wasserman K. A noninvasive assessment of pulmonary perfusion abnormality in patients with primary pulmonary hypertension. Chest 2001;119:824-832.
82. Miller A, Brown LK, Sloane MF, Bhuptani A, Teirstein AS. Cardiorespiratory responses to incremental exercise in sarcoidosis patients with normal spirometry. Chest 1995;107:323-329.
83. Valli G, Vizza CD, Onorati P, Badagliacca R, Ciuffa R, Poscia R, Brandimarte F, Fedele F, Serra P, Palange P. Pathophysiological adaptations to walking and cycling in primary pulmonary hypertension. Eur J Appl Physiol 2008;102:417-424.
84. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status. Am J Respir Crit Care Med 2003;167:544-549.
85. Hiraga T, Maekura R, Okuda Y, Okamoto T, Hirotani A, Kitada S, Yoshimura K, Yokota S, Ito M, Ogura T. Prognostic predictors for survival in patients with COPD using cardiopulmonary exercise testing. Clin Physiol Funct Imaging 2003; 23:324-331.
86. Fell CD, Liu LX, Motika C, Kazerooni EA, Gross BH, Travis WD, Colby TV, Murray S, Toews GB, Martinez FJ, Flaherty KR. The prognostic value of cardiopulmonary exercise testing in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2009;179:402-407.
87. Miki K, Maekura R, Hiraga T, Okuda Y, Okamoto T, Hirotani A, Ogura T. Impairments and prognostic factors for survival in patients with idiopathic pulmonary fibrosis. Respir Med 2003;97:482-490.
88. Colice GL, Shafazand S, Griffin JP, Keenan R, Bolliger CT. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines, 2nd ed. Chest 2007;132:161S-177S.
89. Torchio R, Guglielmo M, Giardino R, Ardissone F, Ciacco C, Gulotta C, Veljkovic A, Bugiani M. Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer. Eur J Cardiothorac Surg 2010;38:14-19.
90. Holverda S, Bogaard HJ, Groepenhoff H, Postmus PE, Boonstra A, Vonk-Noordegraaf A. Cardiopulmonary exercise test characteristics in patients with chronic obstructive pulmonary disease and associated pulmonary hypertension. Respiration 2008;76:160-167.
91. Glaser S, Noga O, Koch B, Opitz CF, Schmidt B, Temmesfeld B, Dörr M, Ewert R, Schäper C. Impact of pulmonary hypertension on gas exchange and exercise capacity in patients with pulmonary fibrosis. Respir Med 2009;103: 317-324.
92. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001;104: 1694-1740.
93. Pinkstaff S, Peberdy MA, Fabiato A, Finucane S, Arena R. The clinical utility of cardiopulmonary exercise testing in suspected or confirmed myocardial ischemia. Am J Lifestyle Med 2010;4:327-348.
94. Dominguez-Rodriguez A, Abreu-Gonzalez P, Avanzas P, Gomez MA, Padron AL, Kaski JC. Cardiopulmonary exercise testing for the assessment of exercise capacity in patients with cardiac syndrome X. Int J Cardiol 2012;154:85-87.
95. Belardinelli R, Lacalaprice F, Carle F, Minnucci A, Cianci G, Perna G, D'Eusanio G. Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing. Eur Heart J 2003;24:1304-1313.
96. Kim ES, Ishwaran H, Blackstone E, Lauer MS. External prognostic validations and comparisons of age-and gender-adjusted exercise capacity predictions. J Am Coll Cardiol 2007;50:1867-1875.
97. Jeppesen TD, Schwartz M, Olsen DB, Vissing J. Oxidative capacity correlates with muscle mutation load in mitochondrial myopathy. Ann Neurol 2003;54: 86-92.
98. Tarnopolsky M. Exercise testing as a diagnostic entity in mitochondrial myopathies. Mitochondrion 2004;4:529-542.
99. Baba R, Nagashima M, Goto M, Nagano Y, Yokota M, Tauchi N, Nishibata K. Oxygen intake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relationship between oxygen consumption and minute ventilation during incremental exercise. Nagoya J Med Sci 1996;59:55-62.
100. Davies LC,Wensel R, Georgiadou P, Cicoira M, Coats AJ, Piepoli MF, Francis DP. Enhanced prognostic value from cardiopulmonary exercise testing in chronic heart failure by non-linear analysis: oxygen uptake efficiency slope. Eur Heart J 2006;27:684-690.
101. Pinkstaff S, Peberdy MA, Kontos MC, Fabiato A, Finucane S, Arena R. Usefulness of decrease in oxygen uptake efficiency slope to identify myocardial perfusion defects in men undergoing myocardial ischemic evaluation. Am J Cardiol 2010; 106:1534-1539.
102. Cohen-Solal A, Tabet JY, Logeart D, Bourgoin P, Tokmakova M, Dahan M. A noninvasively determined surrogate of cardiac power ('circulatory power') at peak exercise is a powerful prognostic factor in chronic heart failure. Eur Heart J 2002;23:806-814.
103. Taniguchi Y, Ueshima K, Chiba I, Segawa I, Kobayashi N, Saito M, Hiramori K.Anew method using pulmonary gas-exchange kinetics to evaluate efficacy of betablocking agents in patients with dilated cardiomyopathy. Chest 2003;124:954-961.
104. Alexander NB, Dengel DR, Olson RJ, Krajewski KM. Oxygen-uptake (VO2) kinetics and functional mobility performance in impaired older adults. J Gerontol A Biol Sci Med Sci 2003;58:M734-M739.
105. Giardini A, Donti A, Specchia S, Coutsoumbas G, Formigari R, Prandstraller D, Bronzetti G, Bonvicini M, Picchio FM. Recovery kinetics of oxygen uptake is prolonged in adults with an atrial septal defect and improves after transcatheter closure. Am Heart J 2004;147:910-914.
106. Guazzi M, Belletti S, Tumminello G, Fiorentini C, Guazzi MD. Exercise hyperventilation, dyspnea sensation, and ergoreflex activation in lone atrial fibrillation. Am J Physiol Heart Circ Physiol 2004;287:H2899-H2905.
107. Agostoni P, Emdin M, Corrà U, Veglia F, Magrs? D, Tedesco CC, Berton E, Passino C, Bertella E, Re F, Mezzani A, Belardinelli R, Colombo C, La Gioia R, Vicenzi M, Giannoni A, Scrutinio D, Giannuzzi P, Tondo C, Di Lenarda A, Sinagra G, Piepoli MF, Guazzi M. Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients. Eur Heart J 2008;29: 2367-2372.