Clinical Interpretation of Cardiopulmonary Exercise Testing: Current Pitfalls and Limitations
Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms....
Uložené v:
| Vydané v: | Frontiers in physiology Ročník 12; s. 552000 |
|---|---|
| Hlavní autori: | , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
Switzerland
Frontiers
18.03.2021
Frontiers Media S.A |
| Predmet: | |
| ISSN: | 1664-042X, 1664-042X |
| On-line prístup: | Získať plný text |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O
2
) despite a low peak WR. Among the determinants of V̇O
2
, only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O
2
delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that “the lungs” are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased “wasted” ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO
2
might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician. |
|---|---|
| AbstractList | Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O2) despite a low peak WR. Among the determinants of V̇O2, only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O2 delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that “the lungs” are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased “wasted” ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO2 might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician. Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O 2 ) despite a low peak WR. Among the determinants of V̇O 2 , only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O 2 delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that “the lungs” are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased “wasted” ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO 2 might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician. Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O 2 ) despite a low peak WR. Among the determinants of V̇O 2 , only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O 2 delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that “the lungs” are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased “wasted” ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO 2 might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician. Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O2) despite a low peak WR. Among the determinants of V̇O2, only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O2 delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that "the lungs" are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased "wasted" ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO2 might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician.Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O2) despite a low peak WR. Among the determinants of V̇O2, only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O2 delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that "the lungs" are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased "wasted" ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO2 might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician. Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremost relevance: prolixity and redundancy should be avoided. Submaximal dyspnea ratings should be plotted as a function of work rate (WR) and ventilatory demand. Increased work of breathing and/or obesity may normalize peak oxygen uptake (V̇O ) despite a low peak WR. Among the determinants of V̇O , only heart rate is measured during non-invasive CPET. It follows that in the absence of findings suggestive of severe impairment in O delivery, the boundaries between inactivity and early cardiovascular disease are blurred in individual subjects. A preserved breathing reserve should not be viewed as evidence that "the lungs" are not limiting the subject. In this context, measurements of dynamic inspiratory capacity are key to uncover abnormalities germane to exertional dyspnea. A low end-tidal partial pressure for carbon dioxide may indicate either increased "wasted" ventilation or alveolar hyperventilation; thus, direct measurements of arterial (or arterialized) PO might be warranted. Differentiating a chaotic breathing pattern from the normal breath-by-breath noise might be complex if the plotted data are not adequately smoothed. A sober recognition of these limitations, associated with an interpretation report free from technicalities and convoluted terminology, is crucial to enhance the credibility of CPET in the eyes of the practicing physician. |
| Author | Phillips, Devin B. O’Donnell, Denis E. Bernard, Anne-Catherine Berton, Danilo C. Neder, J. Alberto Marillier, Mathieu |
| AuthorAffiliation | 1 Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen’s University and Kingston General Hospital , Kingston, ON , Canada 2 Division of Respirology, Federal University of Rio Grande do Sul , Porto Alegre , Brazil |
| AuthorAffiliation_xml | – name: 1 Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen’s University and Kingston General Hospital , Kingston, ON , Canada – name: 2 Division of Respirology, Federal University of Rio Grande do Sul , Porto Alegre , Brazil |
| Author_xml | – sequence: 1 givenname: J. Alberto surname: Neder fullname: Neder, J. Alberto – sequence: 2 givenname: Devin B. surname: Phillips fullname: Phillips, Devin B. – sequence: 3 givenname: Mathieu surname: Marillier fullname: Marillier, Mathieu – sequence: 4 givenname: Anne-Catherine surname: Bernard fullname: Bernard, Anne-Catherine – sequence: 5 givenname: Danilo C. surname: Berton fullname: Berton, Danilo C. – sequence: 6 givenname: Denis E. surname: O’Donnell fullname: O’Donnell, Denis E. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33815128$$D View this record in MEDLINE/PubMed https://hal.science/hal-04827877$$DView record in HAL |
| BookMark | eNp9kk1v3CAQhq0qVfPR_IBeKh_bw24BYxt6qBRZabLSSu0hlXqpEIZhlwjDFuyo-fdl422U5FAJBJp552GGmdPiyAcPRfEOo2VVMf7J7Lb3aUkQwcu6JgihV8UJbhq6QJT8PHpyPy7OU7rNAkRR1uE3xXEG4BoTdlL86pz1VklXrvwIcRdhlKMNvgym7GTUNuwmNwQv4315-QeisgnKG0ij9ZvPZTfFCH4sv9vRSOdSKb0u13awMyS9LV5ne4Lzw3lW_Ph6edNdL9bfrlbdxXqhKOfjQvcN0dLgNi-gNSEKKACRqsKo5Vr3KhfcAiOoajA2vDdgsOaG4IplL6nOitXM1UHeil20Q85XBGnFgyHEjZBxtMqBkIbUPcqbtQ3t-6aXimuoGkqrmhu8Z32ZWbupH0CrXF-U7hn0ucfbrdiEO8FQ_lFOM-DjDNi-CLu-WIu9DVFGWta2dzhrPxwei-H3lL9VDDYpcE56CFMSpEaMccR5k6Xvn-b1SP7XyyzAs0DFkFIE8yjBaK_i4mFkxH5kxDwyOaZ9EaMOvculWfefyL8mYsjH |
| CitedBy_id | crossref_primary_10_1016_j_ijcchd_2024_100546 crossref_primary_10_1080_09638288_2024_2340704 crossref_primary_10_14814_phy2_15397 crossref_primary_10_3390_s21186233 crossref_primary_10_1016_j_pulmoe_2023_02_011 crossref_primary_10_1016_j_ccm_2025_04_007 crossref_primary_10_14814_phy2_15934 crossref_primary_10_1093_jamia_ocaf051 crossref_primary_10_1016_j_ft_2024_09_006 crossref_primary_10_3390_jcm14082538 crossref_primary_10_3389_fphys_2021_668144 crossref_primary_10_1016_j_jelectrocard_2023_11_007 crossref_primary_10_1513_AnnalsATS_202304_332CC crossref_primary_10_1016_j_rmed_2023_107249 crossref_primary_10_1016_j_amjcard_2024_11_029 crossref_primary_10_1371_journal_pone_0295430 crossref_primary_10_1055_a_1651_7450 crossref_primary_10_1080_17476348_2022_2030222 crossref_primary_10_1111_jce_70042 crossref_primary_10_3390_jcm14072493 crossref_primary_10_1109_JBHI_2022_3206100 crossref_primary_10_1016_j_rmed_2021_106713 crossref_primary_10_1080_17476348_2025_2474138 |
| Cites_doi | 10.1007/BF00236685 10.1590/S0100-879X1998000500006 10.1146/annurev.ph.45.030183.002341 10.1183/20734735.009717 10.1155/2013/686104 10.1016/j.ccm.2019.02.014 10.1097/00008483-198704000-00014 10.1164/ajrccm/145.6.1339 10.1249/00003677-197700050-00010 10.1016/j.resp.2016.08.005 10.1183/09031936.00046906 10.1016/j.ccm.2013.09.008 10.1183/16000617.0088-2015 10.1152/jappl.1993.74.4.2016 10.1155/2013/956081 10.1152/jappl.1986.60.6.2020 10.1378/chest.14-0800 10.1080/15412555.2019.1631776 10.3389/fphys.2017.00082 10.1164/arrd.1975.112.2.219 10.1378/chest.106.5.1476 10.1242/jeb.100.1.175 10.1152/jappl.1992.73.3.937 10.1016/j.resp.2013.04.020 10.1016/j.rmed.2019.09.007 10.1183/09031936.03.00045402 10.1161/CIRCULATIONAHA.110.940577 10.1111/resp.12619 10.1164/arrd.1984.129.2P2.S90 10.1016/j.pcad.2017.03.002 10.1183/09031936.00074208 10.1183/13993003.00191-2020 10.1183/09031936.93.04080917 10.1164/rccm.201704-0675OC 10.1378/chest.116.2.488 10.1183/13993003.01518-2019 10.1152/jappl.1973.35.2.236 10.1513/AnnalsATS.201612-955FR 10.1055/s-2000-8885 10.1016/s0735-1097(03)00460-1 10.1164/rccm.201504-0841OC 10.1164/arrd.1984.129.2P2.S49 10.1161/CIRCULATIONAHA.109.914788 10.1164/rccm.201501-0084ED 10.1378/chest.07-0619 10.1249/01.mss.0000218141.90442.6c 10.1183/09031936.00135514 10.1093/oxfordjournals.bmb.a070002 |
| ContentType | Journal Article |
| Copyright | Copyright © 2021 Neder, Phillips, Marillier, Bernard, Berton and O’Donnell. Distributed under a Creative Commons Attribution 4.0 International License Copyright © 2021 Neder, Phillips, Marillier, Bernard, Berton and O’Donnell. 2021 Neder, Phillips, Marillier, Bernard, Berton and O’Donnell |
| Copyright_xml | – notice: Copyright © 2021 Neder, Phillips, Marillier, Bernard, Berton and O’Donnell. – notice: Distributed under a Creative Commons Attribution 4.0 International License – notice: Copyright © 2021 Neder, Phillips, Marillier, Bernard, Berton and O’Donnell. 2021 Neder, Phillips, Marillier, Bernard, Berton and O’Donnell |
| DBID | AAYXX CITATION NPM 7X8 1XC 5PM DOA |
| DOI | 10.3389/fphys.2021.552000 |
| DatabaseName | CrossRef PubMed MEDLINE - Academic Hyper Article en Ligne (HAL) PubMed Central (Full Participant titles) DOAJ Directory of Open Access Journals |
| DatabaseTitle | CrossRef PubMed MEDLINE - Academic |
| DatabaseTitleList | CrossRef MEDLINE - Academic PubMed |
| Database_xml | – sequence: 1 dbid: DOA name: DOAJ Directory of Open Access Journals url: https://www.doaj.org/ sourceTypes: Open Website – sequence: 2 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 3 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Anatomy & Physiology |
| EISSN | 1664-042X |
| ExternalDocumentID | oai_doaj_org_article_af25b025b8764bb6bac9de3644359f12 PMC8012894 oai:HAL:hal-04827877v1 33815128 10_3389_fphys_2021_552000 |
| Genre | Journal Article |
| GroupedDBID | 53G 5VS 9T4 AAFWJ AAKDD AAYXX ACGFO ACGFS ADBBV ADRAZ AENEX AFPKN ALMA_UNASSIGNED_HOLDINGS AOIJS BCNDV CITATION DIK EMOBN F5P GROUPED_DOAJ GX1 HYE KQ8 M48 M~E O5R O5S OK1 PGMZT RNS RPM ACXDI IAO IEA IHR IHW IPNFZ ISR NPM RIG 7X8 1XC 5PM |
| ID | FETCH-LOGICAL-c499t-db62daf17f17e4522ce4ee2ac31079ddbc3897e8203611f9bfef1d9f2138ddb23 |
| IEDL.DBID | DOA |
| ISICitedReferencesCount | 26 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000635546600001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1664-042X |
| IngestDate | Fri Oct 03 12:52:14 EDT 2025 Tue Sep 30 16:54:35 EDT 2025 Tue Oct 14 20:57:27 EDT 2025 Fri Sep 05 08:41:07 EDT 2025 Thu Jan 02 22:57:14 EST 2025 Sat Nov 29 04:01:49 EST 2025 Tue Nov 18 22:00:25 EST 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Keywords | exercise dyspnea lung function exercise test interpretation cardiopulmonal capacity |
| Language | English |
| License | Copyright © 2021 Neder, Phillips, Marillier, Bernard, Berton and O’Donnell. Distributed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c499t-db62daf17f17e4522ce4ee2ac31079ddbc3897e8203611f9bfef1d9f2138ddb23 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Reviewed by: Alessandro Capucci, Marche Polytechnic University, Italy; John Williams, Royal Derby Hospital, United Kingdom Edited by: Bethan E. Phillips, University of Nottingham, United Kingdom This article was submitted to Clinical and Translational Physiology, a section of the journal Frontiers in Physiology |
| OpenAccessLink | https://doaj.org/article/af25b025b8764bb6bac9de3644359f12 |
| PMID | 33815128 |
| PQID | 2508890996 |
| PQPubID | 23479 |
| ParticipantIDs | doaj_primary_oai_doaj_org_article_af25b025b8764bb6bac9de3644359f12 pubmedcentral_primary_oai_pubmedcentral_nih_gov_8012894 hal_primary_oai_HAL_hal_04827877v1 proquest_miscellaneous_2508890996 pubmed_primary_33815128 crossref_primary_10_3389_fphys_2021_552000 crossref_citationtrail_10_3389_fphys_2021_552000 |
| PublicationCentury | 2000 |
| PublicationDate | 2021-03-18 |
| PublicationDateYYYYMMDD | 2021-03-18 |
| PublicationDate_xml | – month: 03 year: 2021 text: 2021-03-18 day: 18 |
| PublicationDecade | 2020 |
| PublicationPlace | Switzerland |
| PublicationPlace_xml | – name: Switzerland |
| PublicationTitle | Frontiers in physiology |
| PublicationTitleAlternate | Front Physiol |
| PublicationYear | 2021 |
| Publisher | Frontiers Frontiers Media S.A |
| Publisher_xml | – name: Frontiers – name: Frontiers Media S.A |
| References | Koch (ref20) 2009; 33 Faisal (ref10) 2016; 193 Beaver (ref3) 1986; 60 Arena (ref1) 2011; 123 Babb (ref2) 1993; 74 Varga (ref45) 2016; 234 Wasserman (ref46) 1987 Rocha (ref44) 2017; 196 Lewis (ref23) 1994; 106 Johnson (ref15) 1999; 116 Neder (ref29); 158 Jones (ref16) 1988 Guenette (ref11) 2013; 2013 Kearon (ref17) 1991; 4 McLoughlin (ref26) 1992; 73 Laveneziana (ref21) 2017; 13 Leite (ref22) 2003; 41 Wasserman (ref47) 1975; 112 Plataki (ref43) 2013; 189 Neder (ref35) 2000; 21 Neder (ref32) Neder (ref31) 2020; 56 Dumitrescu (ref8) 2017; 14 Whipp (ref50) 1977; 5 Myers (ref27) 2017; 60 Campbell (ref6) 1963; 19 O’Donnell (ref39) 2014; 35 Brubaker (ref5) 2011; 123 Boulding (ref4) 2016; 25 Neder (ref33) 2003; 21 Wasserman (ref48) 1973; 35 Hansen (ref12) 1984; 129 Mahler (ref24) 2015; 147 Whipp (ref51) 1984; 129 O’Donnell (ref40) 2019; 40 Casaburi (ref7) 2015; 191 Hoffmann (ref14) 1990; 61 O’Donnell (ref38) 2017; 8 Marciniuk (ref25) 2013; 2013 Killian (ref19) 1992; 145 Neder (ref30); 16 Hansen (ref13) 2007; 132 Palange (ref9) 2007; 29 Plachi (ref42) 2020; 55 Neder (ref36) 1998; 31 Killian (ref18) 1983; 45 Neder (ref34) O’Donnell (ref41) 2016; 21 Whipp (ref52) 1982; 100 Weisman (ref49) 1996; 41 Neder (ref37) 2006; 38 Neder (ref28) 2015; 45 |
| References_xml | – volume: 61 start-page: 1 year: 1990 ident: ref14 article-title: Comparison of arterial, end-tidal and transcutaneous PCO2 during moderate exercise and external CO2 loading in humans publication-title: Eur. J. Appl. Physiol. doi: 10.1007/BF00236685 – volume: 31 start-page: 639 year: 1998 ident: ref36 article-title: Differences between remaining ability and loss of capacity in maximum aerobic impairment publication-title: Braz. J. Med. Biol. Res. doi: 10.1590/S0100-879X1998000500006 – volume: 45 start-page: 465 year: 1983 ident: ref18 article-title: Dyspnea and exercise publication-title: Annu. Rev. Physiol. doi: 10.1146/annurev.ph.45.030183.002341 – volume: 13 start-page: 163 year: 2017 ident: ref21 article-title: Clinical exercise testing: basic principles and practice publication-title: Breathe doi: 10.1183/20734735.009717 – volume: 2013 start-page: 686104 year: 2013 ident: ref25 article-title: Cardiopulmonary exercise testing publication-title: Pulm. Med. doi: 10.1155/2013/686104 – volume: 40 start-page: 471 year: 2019 ident: ref40 article-title: Unraveling the causes of unexplained dyspnea: the value of exercise testing publication-title: Clin. Chest Med. doi: 10.1016/j.ccm.2019.02.014 – volume-title: Principles of exercise testing and interpretation year: 1987 ident: ref46 doi: 10.1097/00008483-198704000-00014 – volume: 145 start-page: 1339 year: 1992 ident: ref19 article-title: Dyspnea and leg effort during incremental cycle ergometry publication-title: Am. Rev. Respir. Dis. doi: 10.1164/ajrccm/145.6.1339 – volume: 5 start-page: 295 year: 1977 ident: ref50 article-title: The hyperpnea of dynamic muscular exercise publication-title: Exerc. Sport Sci. Rev. doi: 10.1249/00003677-197700050-00010 – volume: 234 start-page: 79 year: 2016 ident: ref45 article-title: Relation of concavity in the expiratory flow-volume loop to dynamic hyperinflation during exercise in COPD publication-title: Respir. Physiol. Neurobiol. doi: 10.1016/j.resp.2016.08.005 – volume: 29 start-page: 185 year: 2007 ident: ref9 article-title: Recommendations on the use of exercise testing in clinical practice publication-title: Eur. Respir. J. doi: 10.1183/09031936.00046906 – volume: 35 start-page: 51 year: 2014 ident: ref39 article-title: Chronic obstructive pulmonary disease: clinical integrative physiology publication-title: Clin. Chest Med. doi: 10.1016/j.ccm.2013.09.008 – volume: 25 start-page: 287 year: 2016 ident: ref4 article-title: Dysfunctional breathing: a review of the literature and proposal for classification publication-title: Eur. Respir. Rev. doi: 10.1183/16000617.0088-2015 – volume: 74 start-page: 2016 year: 1993 ident: ref2 article-title: Estimation of ventilatory capacity during submaximal exercise publication-title: J. Appl. Physiol. doi: 10.1152/jappl.1993.74.4.2016 – volume: 2013 start-page: 956081 year: 2013 ident: ref11 article-title: Inspiratory capacity during exercise: measurement, analysis, and interpretation publication-title: Pulm. Med. doi: 10.1155/2013/956081 – volume: 60 start-page: 2020 year: 1986 ident: ref3 article-title: A new method for detecting anaerobic threshold by gas exchange publication-title: J. Appl. Physiol. doi: 10.1152/jappl.1986.60.6.2020 – volume: 147 start-page: 232 year: 2015 ident: ref24 article-title: Recent advances in dyspnea publication-title: Chest doi: 10.1378/chest.14-0800 – volume: 16 start-page: 174 ident: ref30 article-title: Inspiratory constraints and ventilatory inefficiency are superior to breathing reserve in the assessment of exertional dyspnea in COPD publication-title: COPD doi: 10.1080/15412555.2019.1631776 – volume: 8 start-page: 82 year: 2017 ident: ref38 article-title: Advances in the evaluation of respiratory pathophysiology during exercise in chronic lung diseases publication-title: Front. Physiol. doi: 10.3389/fphys.2017.00082 – volume: 112 start-page: 219 year: 1975 ident: ref47 article-title: Exercise physiology in health and disease publication-title: Am. Rev. Respir. Dis. doi: 10.1164/arrd.1975.112.2.219 – volume: 106 start-page: 1476 year: 1994 ident: ref23 article-title: Inaccuracy of noninvasive estimates of VD/VT in clinical exercise testing publication-title: Chest doi: 10.1378/chest.106.5.1476 – volume: 100 start-page: 175 year: 1982 ident: ref52 article-title: Cardiopulmonary coupling during exercise publication-title: J. Exp. Biol. doi: 10.1242/jeb.100.1.175 – volume: 73 start-page: 937 year: 1992 ident: ref26 article-title: Use of arterialized venous blood sampling during incremental exercise tests publication-title: J. Appl. Physiol. doi: 10.1152/jappl.1992.73.3.937 – volume: 189 start-page: 354 year: 2013 ident: ref43 article-title: Clinical consequences of altered chemoreflex control publication-title: Respir. Physiol. Neurobiol. doi: 10.1016/j.resp.2013.04.020 – volume: 158 start-page: 6 ident: ref29 article-title: The role of evaluating inspiratory constraints and ventilatory inefficiency in the investigation of dyspnea of unclear etiology publication-title: Respir. Med. doi: 10.1016/j.rmed.2019.09.007 – volume: 21 start-page: 530 year: 2003 ident: ref33 article-title: The pattern and timing of breathing during incremental exercise: a normative study publication-title: Eur. Respir. J. doi: 10.1183/09031936.03.00045402 – volume: 123 start-page: 1010 year: 2011 ident: ref5 article-title: Chronotropic incompetence: causes, consequences, and management publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.110.940577 – volume: 21 start-page: 211 year: 2016 ident: ref41 article-title: Physiological impairment in mild COPD publication-title: Respirology doi: 10.1111/resp.12619 – volume: 129 start-page: S90 year: 1984 ident: ref51 article-title: The ventilatory stress of exercise in obesity publication-title: Am. Rev. Respir. Dis. doi: 10.1164/arrd.1984.129.2P2.S90 – volume: 60 start-page: 21 year: 2017 ident: ref27 article-title: A reference equation for normal standards for VO2 max: analysis from the fitness registry and the importance of exercise national database (FRIEND registry) publication-title: Prog. Cardiovasc. Dis. doi: 10.1016/j.pcad.2017.03.002 – volume: 33 start-page: 389 year: 2009 ident: ref20 article-title: Reference values for cardiopulmonary exercise testing in healthy volunteers: the SHIP study publication-title: Eur. Respir. J. doi: 10.1183/09031936.00074208 – volume: 56 start-page: 2000191 year: 2020 ident: ref31 article-title: A frame of reference for assessing the intensity of exertional dyspnoea during incremental cycle ergometry publication-title: Eur. Respir. J. doi: 10.1183/13993003.00191-2020 – volume: 4 start-page: 917 year: 1991 ident: ref17 article-title: Effort and dyspnoea during work of varying intensity and duration publication-title: Eur. Respir. J. doi: 10.1183/09031936.93.04080917 – volume: 196 start-page: 1264 year: 2017 ident: ref44 article-title: Excess ventilation in COPD-heart failure overlap: implications for dyspnea and exercise intolerance publication-title: Am. J. Respir. Crit. Care Med. doi: 10.1164/rccm.201704-0675OC – volume: 116 start-page: 488 year: 1999 ident: ref15 article-title: Emerging concepts in the evaluation of ventilatory limitation during exercise: the exercise tidal flow-volume loop publication-title: Chest doi: 10.1378/chest.116.2.488 – volume: 55 start-page: 1901518 year: 2020 ident: ref42 article-title: Exertional dyspnoea-ventilation relationship to discriminate respiratory from cardiac impairment publication-title: Eur. Respir. J. doi: 10.1183/13993003.01518-2019 – start-page: x volume-title: 2018 clinical exercise testing european respiratory monograph ident: ref34 article-title: CPET in clinical practice. Recent advances, current challenges and future directions – volume: 35 start-page: 236 year: 1973 ident: ref48 article-title: Anaerobic threshold and respiratory gas exchange during exercise publication-title: J. Appl. Physiol. doi: 10.1152/jappl.1973.35.2.236 – volume: 14 start-page: S12 year: 2017 ident: ref8 article-title: Graphical data display for clinical cardiopulmonary exercise testing publication-title: Ann. Am. Thorac. Soc. doi: 10.1513/AnnalsATS.201612-955FR – volume-title: Clinical exercise testing year: 1988 ident: ref16 – volume: 21 start-page: 263 year: 2000 ident: ref35 article-title: Oxygen cost for cycling as related to leg mass in males and females, aged 20 to 80 publication-title: Int. J. Sports Med. doi: 10.1055/s-2000-8885 – volume: 41 start-page: 2175 year: 2003 ident: ref22 article-title: Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation publication-title: J. Am. Coll. Cardiol. doi: 10.1016/s0735-1097(03)00460-1 – volume: 193 start-page: 299 year: 2016 ident: ref10 article-title: Common mechanisms of dyspnea in chronic interstitial and obstructive lung disorders publication-title: Am. J. Respir. Crit. Care Med. doi: 10.1164/rccm.201504-0841OC – volume: 129 start-page: S49 year: 1984 ident: ref12 article-title: Predicted values for clinical exercise testing publication-title: Am. Rev. Respir. Dis. doi: 10.1164/arrd.1984.129.2P2.S49 – volume: 123 start-page: 668 year: 2011 ident: ref1 article-title: Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.109.914788 – volume: 191 start-page: 873 year: 2015 ident: ref7 article-title: Exercise limitation in chronic obstructive pulmonary disease. The O’Donnell threshold publication-title: Am. J. Respir. Crit. Care Med. doi: 10.1164/rccm.201501-0084ED – volume: 41 start-page: 621 year: 1996 ident: ref49 article-title: Clinical evaluation of unexplained dyspnea publication-title: Cardiologia – volume: 132 start-page: 977 year: 2007 ident: ref13 article-title: Mixed-expired and end-tidal CO2 distinguish between ventilation and perfusion defects during exercise testing in patients with lung and heart diseases publication-title: Chest doi: 10.1378/chest.07-0619 – volume: 38 start-page: 1007 year: 2006 ident: ref37 article-title: A simplified strategy for the estimation of the exercise ventilatory thresholds publication-title: Med. Sci. Sports Exerc. doi: 10.1249/01.mss.0000218141.90442.6c – volume: 45 start-page: 377 year: 2015 ident: ref28 article-title: Exercise ventilatory inefficiency in mild to end-stage COPD publication-title: Eur. Respir. J. doi: 10.1183/09031936.00135514 – volume: 19 start-page: 36 year: 1963 ident: ref6 article-title: The sensation of breathlessness publication-title: Br. Med. Bull. doi: 10.1093/oxfordjournals.bmb.a070002 – start-page: 34 volume-title: 2018 clinical exercise testing European respiratory monograph ident: ref32 article-title: Abnormal patterns of response to incremental CPET |
| SSID | ssj0000402001 |
| Score | 2.4022968 |
| Snippet | Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For... |
| SourceID | doaj pubmedcentral hal proquest pubmed crossref |
| SourceType | Open Website Open Access Repository Aggregation Database Index Database Enrichment Source |
| StartPage | 552000 |
| SubjectTerms | cardiopulmonal capacity dyspnea exercise exercise test interpretation Life Sciences lung function Physiology |
| Title | Clinical Interpretation of Cardiopulmonary Exercise Testing: Current Pitfalls and Limitations |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/33815128 https://www.proquest.com/docview/2508890996 https://hal.science/hal-04827877 https://pubmed.ncbi.nlm.nih.gov/PMC8012894 https://doaj.org/article/af25b025b8764bb6bac9de3644359f12 |
| Volume | 12 |
| WOSCitedRecordID | wos000635546600001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| journalDatabaseRights | – providerCode: PRVAON databaseName: DOAJ Directory of Open Access Journals customDbUrl: eissn: 1664-042X dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0000402001 issn: 1664-042X databaseCode: DOA dateStart: 20100101 isFulltext: true titleUrlDefault: https://www.doaj.org/ providerName: Directory of Open Access Journals – providerCode: PRVHPJ databaseName: ROAD: Directory of Open Access Scholarly Resources (ISSN International Center) customDbUrl: eissn: 1664-042X dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0000402001 issn: 1664-042X databaseCode: M~E dateStart: 20100101 isFulltext: true titleUrlDefault: https://road.issn.org providerName: ISSN International Centre |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1Nb9QwEB1BxYELAspHoFQGIQ5IoWvHG9vclmqrHqDqoUh7QZEd23SlNFttdyv1wm_vjJOuNiDBBSnKwXYSxzPOvLEnbwDeaxlliJLnSjqfS87LXAdrclSPsihDEDjZU7IJdXKiZzNzupXqi2LCOnrgbuAObBRjh4bZ4bSVzpXO1saHAs14MTYx5RcWiHq2nKn0DSa3aMS7bUz0wsxBpJUC9AcF_zQmqqHRwBAlvn40L-cUDfkn1Pw9YnLLBB09hkc9dmSTrs9P4F5on8LupEW_-eKGfWApmjMtk-_Cj57ws2HDsEK2iOwwxaBerhtUQbu8YdM-7RI7I8qN9udn1rM2sdP5KtqmuWK29Sz9C9Ut8D2D70fTs8PjvE-lkNfo0qxy70rhbeQKj0Ak6nWQKAhbI7pTxntX4xipoGlbkvNoXAyRexMFLzTWiuI57LSLNrwEZkX0Tpa-1JbLWiHCQIwQRsJEKSR-rTIY3Y1rVffdonQXTYX-BomiSqKoSBRVJ4oMPm4uuexINv7W-AsJa9OQ-LFTAWpN1WtN9S-tyeAdinpwj-PJ14rKRkSMqpW65hm8vdOECicd7aTYNizW2B2CtQbBdZnBi04zNvfCXhOK0hmogc4MHjasaefnidg7oQUjX_2PN3wND2nQKFyO6z3YWS3X4Q08qK9X86vlPtxXM72f5gyev_2a3gIh6h2Q |
| linkProvider | Directory of Open Access Journals |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Clinical+Interpretation+of+Cardiopulmonary+Exercise+Testing%3A+Current+Pitfalls+and+Limitations&rft.jtitle=Frontiers+in+physiology&rft.au=Neder%2C+J.+Alberto&rft.au=Phillips%2C+Devin&rft.au=Marillier%2C+Mathieu&rft.au=Bernard%2C+Anne-Catherine&rft.date=2021-03-18&rft.pub=Frontiers&rft.issn=1664-042X&rft.eissn=1664-042X&rft.volume=12&rft_id=info:doi/10.3389%2Ffphys.2021.552000&rft.externalDBID=HAS_PDF_LINK&rft.externalDocID=oai%3AHAL%3Ahal-04827877v1 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1664-042X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1664-042X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1664-042X&client=summon |