🫁 CPET MASTERCLASS: From Exercise Testing to Clinical Decisions How can CPET uncover the cause of unexplained dyspnea, assess heart failure prognosis, and guide treatment? ⏹️ Clinical applications ⏹️ Prognostic markers ⏹️ Disease-specific patterns ⏹️ Interpretation pitfalls One practical guide to understanding CPET. Save. Share.

EXERCISE ECHOCARDIOGRAPHY + CPET: WHAT RESTING TESTS CAN MISS A patient may have relatively reassuring findings at rest but develop major cardiovascular abnormalities during exercise. Combining cardiopulmonary exercise testing (CPET) with exercise echocardiography helps connect symptoms, exercise capacity, gas exchange and cardiac hemodynamics. 1️⃣ HFrEF: impaired cardiac function Reduced LVEF, abnormal diastolic filling, poor ventilatory efficiency and exercise-induced pulmonary hypertension can reveal severe functional limitation. 2️⃣ Obstructive hypertrophic cardiomyopathy (HCM) The LV outflow tract gradient may increase with Valsalva or exercise. Symptoms and dynamic obstruction must be assessed together. 3️⃣ HFpEF: abnormal filling pressures A patient can have preserved LVEF yet develop exercise-induced elevation of filling pressures and pulmonary artery pressure, limiting exercise capacity. 4️⃣ Dynamic mitral regurgitation MR may worsen during exercise, increasing left atrial pressure and pulmonary pressures even when resting MR appears less severe. 5️⃣ What should you look for on CPET? ⭕ Peak VO₂: objective measure of exercise capacity. ⭕ VE/VCO₂ slope: assesses ventilatory efficiency; an elevated value can indicate worse prognosis in heart failure. ⭕ VO₂/work-rate relationship: flattening suggests impaired oxygen delivery or utilization. ⭕ Chronotropic response: an inadequate heart-rate rise may contribute to exercise intolerance. ⭕ Exercise oscillatory ventilation: can be a marker of more advanced heart failure. CPET helps quantify functional limitation and can support advanced heart failure assessment. Exercise echocardiography adds the hemodynamic explanation. In selected patients, combining both tests can uncover abnormalities that a resting echocardiogram alone may miss. References: