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CPET dr ahmed kadry.pptx
- 1. CPET .….. The Gold Standrad AHMEDKADRY,MD LECTURER OF CARDIOLOGY AIN SHAMS UNIVERSITY
- 2. we use Echocardiographyto assess functional capacity in heart failure patients???
- 3. we use Echocardiographyto assess functional capacity in heart failure patients???
- 4. Echocardiography is “thesingle most useful test in the diagnosis & classification of patients with HF, yet it gives little information about functional capacity”
- 5. Functional capacity isbest assessed with Cardiopulmonary exercise (CPET) testing “Gold standard”
- 6. OUTLINE • CPET andits terminology • Exercise physiology • Interpretation of CPET results • Indications in clinical practice
- 7. OUTLINE •CPET and itsterminology • Exercise physiology • Interpretation of CPET results • Indications in clinical practice
- 8. CPET Symptom-limited provocative test Combines 1.ECGstress testing 2.Indices of gas exchange and spirometry
- 9. KEY PARAMETERS • Oxygenuptake • Carbon dioxide production • Minute ventilation( VE=VT *RR) • Heart rate • Oxygen saturation
- 10. KEY DEFINITIONS • Oxygenuptake • Carbon dioxide production • Minute ventilation • Heart rate • Oxygen saturation Ventilatory equivalents for O2 (VO2)
- 11. Oxygen consumption duringexercise(VO2) • VO2 is the amount of O2 utilized by tissues per minute • Peak VO2 is the amount of oxygen utilized by tissues at peak exercise. • Absolute ml/min • Relative ml/mim/kg Reference: • Resting VO2 3.5 ml/kg/min (250 ML/MIN) • Peak VO2 > 84% of predicted or >25 ml/kg/min (30-50 ml/kg/min)
- 12. KEY DEFINITIONS • Oxygenuptake • Carbon dioxide production • Minute ventilation • Heart rate • Oxygen saturation Hyperventilation if assosciated with decreased Etco2 Increased VD/VT if associated with increased Etco2 Ventilatory equivalents for CO2 (Vco2) N < 34
- 13. KEY DEFINITIONS • Oxygenuptake • Carbon dioxide production • Minute ventilation • Heart rate • Oxygen saturation Respiratory exchange ratio (RER)
- 14. Respiratory Exchange Ratio(RER) •Used to determine adequacy of effort • The threshold you can say that this test is adequate regardless target heart rate • RER= VCO2 / VO2 • RER occur near 1 • Values > 1.1 = adequate effort
- 15. KEY DEFINITIONS • Oxygenuptake • Carbon dioxide production • Minute ventilation • Heart rate • Oxygen saturation Oxygen pulse VO2/HR
- 16. Oxygen Pulse • Volumeof oxygen consumed per heart beat • Surrogate to evaluate stroke volume • Vo2/HR = SV(CaO2-Cvo2) Normal • > 80% of predicted(predicted vo2 max/ predicted max HR) • 15 ml/b in men 10 ml/b in women
- 17. OUTLINE • CPET andits terminology •Exercise physiology • Interpretation of CPET results • Indications in clinical practice
- 18. EXERCISE PHYSIOLOGY Fick`s principle explains all aspects of exercise physiology VO2=(CO*(CaO2- CvO2)
- 20. Anaerobic Threshold(AT) • THEpoint of exercise at which the level of VCO2 increases exponentially relative to VO2 • Normal is 55% of predicted peak VO2
- 22. What Limits ANormal Person VO2=CO*(CaO2- CvO2) • COP =(SV*HR) • Is limited by reaching maximal heart rate • Even at this point 25-30% ventilatory reserve is present
- 23. Cardiovascular response toexercise • COP increase linearly with VO2 • Initial increase caused by increase of SV and HR then HR exclusively • HR max =220 –age ( normal to achieve > 90%) • HRR= age predicted HR max – HR max achived ( normal < 15 bpm)
- 24. ABP response toexercise • SVR decrease • Systolic ABP increase with normal diastolic ABP. • Failure of SBP to increase indicates 1. Cardiac limitation 2. Sympathetic dysfunction
- 25. VENTILATORY RESERVE • Potentialventilation in L that could be increased during exercise. • VE=VT*RR • Difference / ratio between VE max and MVV • VEmax / MVV * 100 >75% • Vemax – MVV >11L • MVV (ventilatory mechanical limit)=FEV1*40 LUNG DISEASE REDUCED VENTILATORY RESERVE. HEART DISEASE NORMAL VENTILATORY RESERVE.
- 29. MECHANISMS OF EXERCISELIMITATION Pulmonary • Ventilatory • Respiratory muscle dysfunction • Impaired gas exchange Deconditioning Peripheral Neuromuscular dysfunction Metabolic dysfunction Cardiovascular Reduced stroke volume Abnormal heart rate response Circulatory abnormality
- 36. When VO2 isdecreased ( N >84% ,>25 ml/kg/min) 1. HR reach max limit?? 2. RER>1.15?? 3. Decrease in Etco2?? 4. VE > 75% OF PREDICTED ??? 5. Saturation decrease by 5% or more ???
- 37. When VO2 isdecreased ( N >84% ,>25 ml/kg/min) 1. HR reach max limit?? 2. RER>1.15?? 3. Decrease in Etco2?? 4. VE > 75% OF PREDICTED ??? 5. Saturation decrease by 5% or more ??? cardiac
- 38. When VO2 isdecreased ( N >84% ,>25 ml/kg/min) 1. HR reach max limit?? 2. RER>1.15?? 3. Decrease in Etco2?? 4. VE > 75% OF PREDICTED ??? 5. Saturation decrease by 5% or more ??? ventilatory
- 39. When VO2 isdecreased ( N >84% ,>25 ml/kg/min) 1. HR reach max limit?? 2. RER>1.15?? 3. Decrease in Etco2?? 4. VE > 75% OF PREDICTED ??? 5. Saturation decrease by 5% or more ???
- 40. INDICATIONS OF CPETIN CLINICAL PRACTISE •Unexplained dyspnea •Response to intervention Monitoring disease Preoperative risk assessment