Cardiopulmonary Exercise Testing – Applications Across the Age Spectrum

Watch the recording and review the Q&A from TCACC’s practical, case-based webinar exploring how cardiopulmonary exercise testing can support evaluation and clinical decision-making in adult and pediatric cardiovascular care.

Welcome and Introduction

Keri Shafer, MD and Krishna Pabba, MD

Basics of CPET

Presenter: Meagan Wasfy, MD, MPH

A 10-minute overview of CPET fundamentals, including basic indications, physiologic principles and the role of CPET in evaluating patients with cardiovascular disease.

Adult CPET Case Presentation

Presenter: Keval Patel, MD, PhD

Adult CPET Case Discussion

Discussants: Benjamin Levine, MD; Keri Shafer, MD; Meagan Wasfy, MD, MPH

Pediatric CPET Case Presentation

Presenter: Emily Masterson, MD

Pediatric CPET Case Discussion

Discussants: Tam Dan “Tina” Pham, MD and Katherine Hansen, MD

Audience Q&A and Closing Remarks

A brief audience Q&A followed as time allowed.

CPET and suspected myocarditis or inflammatory processes

Question: Do you worry about doing a CPET in someone who may have myocarditis or an inflammatory process, since they should be on a limited, low-level exercise program?

Response: In general, CPET may still be considered when clinically appropriate. However, CPET would not be recommended if the patient is acutely ill or “toxic,” such as having fever, elevated high-sensitivity troponin, evidence of congestion or other signs that would make exercise testing unsafe.

Interpreting low peak VO₂ in an athletic patient

Question: If we do not have ways to measure cardiac output and stroke volume, is a relatively low peak VO₂ the main objective clue, especially when it is lower than expected for the patient’s fitness level or athletic status?

Response: A lower-than-expected peak VO₂ can be an important objective clue, especially when interpreted in the context of the patient’s baseline fitness, training status and clinical presentation. CPET findings should be interpreted alongside the full clinical picture and other available test results.

O₂ pulse in valvular heart disease

Question: O₂ pulse has been described as inaccurate in patients with coronary artery disease. Does it have better discriminatory ability in valvular heart disease?

Response: O₂ pulse can provide useful information, but it should be interpreted carefully and in context. Its reliability may vary depending on the underlying condition, test quality and patient-specific factors. In valvular heart disease, O₂ pulse may contribute to the overall interpretation, but it should not be used in isolation.

CPET in preventive and lifestyle medicine settings

Question: How does CPET apply to nondiagnostic screenings in preventive or lifestyle medicine clinical settings?

Response: CPET can help provide objective insight into functional capacity, exercise tolerance and cardiopulmonary physiology. In preventive or lifestyle medicine settings, CPET may help inform exercise counseling, risk assessment and individualized recommendations, depending on the clinical context and goals of testing.

Normal peak VO₂ interpretation

Question: What is considered a normal peak VO₂? I thought greater than 80% predicted is normal for an average patient without congenital heart disease. If peak VO₂ is greater than 80% for a child with moderate aortic stenosis, is that considered normal?

Response: Normal thresholds may vary by age, patient population and clinical context. During the webinar discussion, a threshold of greater than 85% predicted was noted as commonly used, while also recognizing that greater than 80% predicted may suggest reassuring or essentially normal exercise capacity in the appropriate clinical context.