Cardiopulmonary exercise testing (
CPET) is a well-accepted physiologic evaluation technique in patients diagnosed with
heart failure and in patients presenting with unexplained
dyspnea on exertion. Several variables obtained during
CPET, including oxygen consumption relative to heart rate and work rate provide consistent, quantitative patterns of abnormal physiologic responses to graded exercise when
left ventricular dysfunction is caused by
myocardial ischemia. This concept report describes both the methodology and clinical application of
CPET associated with
myocardial ischemia. Initial evidence indicates
left ventricular dysfunction induced by
myocardial ischemia may be accurately detected by an abnormal
CPET response.
CPET testing may
complement current noninvasive testing modalities that elicit inducible
ischemia. It provides a physiologic quantification of the work rate, heart rate, and O(2) uptake at which
myocardial ischemia develops. In conclusion, adding
CPET with gas exchange measurements is likely to be of value in diagnosing and quantifying both overt and occult
myocardial ischemia and its reversibility with treatment.