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Randomized Controlled Trial
. 2022 Feb 5:77:100003.
doi: 10.1016/j.clinsp.2021.100003. eCollection 2022.

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Camila R A de Assumpção  1 , Danilo M L do Prado  2 , Camila P Jordão  1 , Luciana O C Dourado  1 , Marcelo L C Vieira  1 , Carla G de S P Montenegro  3 , Carlos E Negrão  4 , Luís H W Gowdak  1 , Luciana D N J De Matos  5
Affiliations
Randomized Controlled Trial

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Camila R A de Assumpção et al. Clinics (Sao Paulo). .

Abstract

Objectives: Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE).

Methods: Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891.

Results: The patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019).

Conclusion: Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography.

Keywords: Cardiopulmonary exercise testing; Exercise capacity; Myocardial ischemia; Oxygen pulse; Oxygen uptake efficiency slope.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

Figures

Fig. 1
Figure 1
Flowchart of patients. CPET, Cardiopulmonary Exercise Testing; CCS, Canadian Cardiovascular Society Class; LVEF, Left Ventricular Ejection Fraction; MI, Myocardial Infarction.
Fig. 2
Figure 2
VO2 response (panel A); O2 pulse response during CPET in patients with refractory angina (panel B); ΔVO2/ΔWR slope (panel C); ΔO2 pulse/ΔWR (panel D). VO2, oxygen consumption; O2 pulse, oxygen pulse; VAT, Ventilatory Anaerobic threshold; Sa, linear response of oxygen consumption as a function of work rate; Sb, loss of linearity or a flattening response of oxygen consumption as a function of work rate. * p < 0.05 vs. rest; # p < 0.05 vs. Sa.
Fig. 3
Figure 3
Relationship between HR at onset of flattening oxygen pulse response detected by CPET and ischemic changes with contractile modifications in the ESE (panel A); and HR at onset of angina detected by CPET and ESE. CPET, cardiopulmonary exercise test; ESE, exercise stress echocardiography.
See this image and copyright information in PMC

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