CPET Test Interpretation, Part 4: Interpretation and Summary

After having gone through the descriptive checklists for ventilatory, gas exchange and circulatory limitations the reason(s) for a patient’s exercise limitation, if any, should be reasonably clear. However, one of the first questions that should be asked when reading an exercise test is what was the purpose of the test?

  • Maximum safe exercise capacity for Pulmonary Rehab?
  • Rule in/rule out exercise-induced bronchospasm?
  • Pre-operative assessment?
  • Dyspnea of uncertain etiology?
  • What is the primary limitation to exercise (pulmonary or cardiac)?
  • Is deconditioning suspected?

The interpretation and summary should address these concerns.

The descriptions checklist is the main groundwork for the actual interpretation and any abnormal findings there may signal the need for specific comments. The interpretation should start by indicating whether or not the patient’s exercise capacity was normal and then should indicate the presence or absence of any limitations.

What was the patient’s maximum exercise capacity (maximum VO2)?

  • >120% = Elevated
  • 80% to 120% = Normal
  • 60% to 79% = Mildly reduced
  • 40% to 59% = Moderately reduced
  • <40% = Severely reduced

Example: There was a {elevated | normal | mildly reduced | moderately reduced | severely reduced} exercise capacity as indicated by the maximum oxygen consumption of XX%.

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CPET Test Interpretation, Part 3: Circulation

I would like to re-emphasize the importance of the descriptive part of CPET interpretation. At the very least consider it to be a checklist that should always be reviewed even when you think you know what the final interpretation is going to be.

After gas exchange, the next step in the flow of gases is circulation. The descriptive elements for assessing circulation are:

What was the maximum heart rate?

The maximum predicted heart rate is calculated from 220 – age.

A maximum heart rate above 85% of predicted indicates that there has been an adequate exercise test effort.

Example: The maximum heart rate was XX% of predicted {which indicates an adequate test effort}.

What was the heart rate reserve?

The heart rate reserve is (predicted heart rate – maximum heart rate). A heart rate reserve that is greater than 20% of the (predicted heart rate – resting heart rate) is elevated and may be an indication of either chronotropic incompetence or an inadequate test effort.

Note: A negative heart rate reserve will occur whenever a patient exceeds their predicted heart rate.

Example: The heart rate reserve is XX BPM which is {within normal limits | elevated}.

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Fick Cardiac Output

We’ve all run across the Fick equation for cardiac output at one time or another. There are very limited circumstances when we’d ever get to use it but at the same time it’s one of those simple but incredibly profound equations that’s also a foundation of pulmonary physiology.

The Fick equation is:

where:

VO2 = oxygen uptake

CvO2 = mixed venous oxygen content

CaO2 = arterial oxygen content

And what it describes is:

It’s a mass-balance equation that basically says that what goes in must come out, but how do you get from oxygen uptake to cardiac output?
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