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. 2025 May 23;14(11):3676.
doi: 10.3390/jcm14113676.

Initial Implementation and Utilization of Cardiopulmonary Exercise Testing at a Pulmonary Department of an Academic Tertiary Care Center: An Overview

Nimrod Kleinhaus  1 , Yael Raviv  2 , Itamar Ben Shitrit  1 , Jonathan Wiesen  2 , Liora Boehm Cohen  2 , Michael Kassirer  2 , Natalya Bilenko  3
Affiliations

Initial Implementation and Utilization of Cardiopulmonary Exercise Testing at a Pulmonary Department of an Academic Tertiary Care Center: An Overview

Nimrod Kleinhaus et al. J Clin Med. .

Abstract

Background: Cardiopulmonary exercise testing (CPET) is a valuable diagnostic and prognostic tool for assessing the integrated function of the cardiopulmonary and muscular systems during exercise. The initiation of a CPET program is complex, and data on early implementation in academic centers remain relatively limited. Objective: to evaluate the initial integration of CPET within a pulmonary department, focusing on patient demographics, referral indications, test performance, and factors associated with anaerobic threshold achievement. Methods: A retrospective cohort study was conducted at a single tertiary care center, including all patients who underwent their first CPET between February 2016 and December 2022. Demographic, clinical, and functional parameters were extracted. Multivariable logistic regression was used to identify variables associated with anaerobic threshold achievement, defined as a respiratory exchange ratio (RER) ≥ 1.1. Results: The cohort included 434 patients (mean age 60.3 ± 14.1 years; 54% male; mean BMI 29.2 ± 5.6 kg/m2). The most common indication for testing was dyspnea (50%). Tests were most frequently terminated due to leg discomfort (39%) and dyspnea (38.8%). Achievement of RER ≥ 1.1 was independently associated with lower BMI (aOR = 0.91; 95% CI: 0.88-0.95; p < 0.001), higher FVC % predicted (aOR = 1.02; 95% CI: 1.00-1.03; p = 0.028), and greater minute ventilation volume (aOR = 1.02; 95% CI: 1.01-1.03; p < 0.001), and it was less likely in patients referred for cardiovascular disease (aOR = 0.37; 95% CI: 0.21-0.64; p < 0.001). No consistent temporal trend in RER achievement was observed across the study period. Conclusions: CPET was most commonly utilized in response to patient-reported dyspnea, with test termination frequently driven by subjective symptoms rather than objective clinical criteria. Anaerobic threshold achievement was more strongly associated with individual physiological characteristics than with institutional experience. These findings underscore the importance of patient preparation and pulmonary functional capacity in optimizing CPET performance.

Keywords: anerobic threshold; cardiopulmonary exercise testing; respiratory exchange ratio.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Data sources and selection process for the eligible cohort. CPET = cardiopulmonary exercise test.
Figure 2
Figure 2
Reasons for CPET administration *. * There can be more than one reason. CPET = cardiopulmonary exercise test; SOB = shortness of breath (dyspnea); CVD = cardiovascular disease.
Figure 3
Figure 3
Distribution of CPET termination reasons *. * There can be more than one reason. CPET = cardiopulmonary exercise test; SOB = shortness of breath (dyspnea); HTN = hypertension.
Figure 4
Figure 4
Annual CPET anaerobic threshold achievement rates with trendline. CPET = cardiopulmonary exercise test; AT = anaerobic threshold.
See this image and copyright information in PMC

References

    1. American Thoracic Society. American College of Chest Physicians ATS/ACCP Statement on cardiopulmonary exercise testing. Am. J. Respir. Crit. Care Med. 2003;167:211–277. doi: 10.1164/rccm.167.2.211. - DOI - PubMed
    1. Mezzani A. Cardiopulmonary Exercise Testing: Basics of Methodology and Measurements. Ann. Am. Thorac. Soc. 2017;14((Suppl. 1)):S3–S11. doi: 10.1513/AnnalsATS.201612-997FR. - DOI - PubMed
    1. DeCato T.W., Haverkamp H., Hegewald M.J. Cardiopulmonary Exercise Testing (CPET) Am. J. Respir. Crit. Care Med. 2020;201:P1–P2. doi: 10.1164/rccm.2011P1. - DOI - PubMed
    1. Balady G.J., Arena R., Sietsema K., Myers J., Coke L., Fletcher G.F., Forman D., Franklin B., Guazzi M., Gulati M., et al. Clinician’s guide to cardiopulmonary exercise testing in adults: A scientific statement from the American heart association. Circulation. 2010;122:191–225. doi: 10.1161/CIR.0b013e3181e52e69. - DOI - PubMed
    1. Durstenfeld M.S., Sun K., Tahir P., Peluso M.J., Deeks S.G., Aras M.A., Grandis D.J., Long C.S., Beatty A., Hsue P.Y. Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults: A Systematic Review and Meta-analysis. JAMA Netw. Open. 2022;5:e2236057. doi: 10.1001/jamanetworkopen.2022.36057. - DOI - PMC - PubMed