Current Trends in Cardiopulmonary Stress Testing

The most frequent Arrhythmia that causes significant global economic implications, mortality and morbidity all over the globe is Atrial Fabrication (AF). The complication causes a stroke to increase by 5-fold, dementia and death surge 2-fold and surge in heart failure of 3-fold. The disease also causes physical and social impairments such as low health and general life quality and mental impairment.  Therefore it is imperative to understand the current trends of stress testing in Cardiopulmonary. The paper provides a detailed description of the current trends in cardiopulmonary stress testing.

To find the current trends of stress testing in cardiopulmonary, this study compared HFpEF patients with AF and non-AF by the use of exercise parameters.  The test undertaken was also to asses if AF is linked to increased mortality. A population of 1744 patients who had EF higher than 50% was tested within six months, and then the patients were sent for clinical diagnosis on heart failure.  After which 85% of these patients were referred from clinics of heart failure to Cleveland clinic to get CPX for 18 years from 1995 to 2013. The patients were put into two groups. The first group was made of the AF patients who had documented AF history and with rhythm at the moment of CPX and group two made of non-AF patients. That is patients with no AF history and with no AF during CPX. These groups of patients were again divided into three subgroups on the basis of HFpEf cause. The first subgroup comprised of patients whose HFpEF originated from coronary artery disease, the second group, Nonischemic and the third group Valvular heart disease.

The current trend of test commenced with exercise protocol where the patients were taken through the maximal, symptom-limited test of metabolic either with the employment of exercise bike or treadmill.  Modified   Naughton, Naughton, Bruce or Cornell protocols were used. The protocol choice to be used by each patient was based on a rough calculation of the capacity of the patient. The chosen protocol was tailored towards making the patients to do a fatigue-limited exercise for a time period of 8 to 12 minutes. All the patients were confirmed to be clinically stable during testing.  They were fasted for four hours prior to testing and afterward went up to the end of the protocol. The issuing of β blockers was stopped 12 hours before testing, and the other medications were routinely provided as usual except in cases prescribed by the physician.

The metabolic cart was used to collect the data of gas exchange throughout the exercise. The physician urged the patients to do continuous training until the time they experience limited symptoms.  The baseline of respiratory rate, arrhythmias, symptoms, blood pressure, electrocardiogram changes, and heart rate was taken (Mohamed, at.el., 2017).  The record of these was also taken during every exercise stage and at recovery.  HR was calculated by subtracting resting HR from peak HR. The following examinations were also done; systolic blood pressure change examination, gas exchange variables, calculation of carbon IV oxide ventilator equivalent, to determine the respiratory exchange ratio. Peak oxygen pulse which is the surrogate for the volume of stroke was also calculated during the exercise protocol.

After the test exercise protocol, statistical analysis was carried out. The data on the clinical relationship with AF was used to determine the medication and the characteristics of the patients. Stress parameter was done between the non-AF and those with AF. The characteristics used to show the link of clinical data to AF included the history of cigarette smoking, body mass index, sex, age, history of diabetes mellitus and hypertension among others. The medications administered to the patients included inotropes, diuretics, angiotensin-converting enzyme inhibitors, β blockers, α blockers, and digitalis. The tests used during the analysis were Student t-test for comparison of standard continuously distributed variables (≠SD). For comparison of categorical data X2 test was used (Statistical confidence level P˂0.05). Due to the variability of LVEF, medications and clinical characteristics between the AF groups and non-AF group’s inverse probability of treatment weighting (IPTW) was used to balance the groups. The use of weighted linear regression offset the cases of unbalanced variables after the application of IPTW. This helped to enhance the comparison of CPX exercise between non-AF and AF patient groups. Mortality status was achieved by the use of the Social Security Death Index.

The results of the population characteristics showed that HFpEF patients with AF had a higher prevalence of digitalis, hypertension, and increased use of β blockers and reduced LVEF as compared to non-AF patients. The HFpEF patients with AF were also found to be older. The results of the parameters of CPX in AF versus non-PF propensity showed that nonischemic was the highest cause of HFpEF standing at 68%. The study also found out that the ratio of mean respiratory was similar in both non-AF and AF standing at ≥1.1 (P=0.053). This shows that the parameters of CPX are not a subject to submaximal peak exercise.  The study also found that AF patients had a higher VE/ VO2 than non-AF. The AF patients also had reduced low metabolic peak equivalents. The anaerobic threshold of VO2 was the same in both groups suggesting a similar capacity of submaximal exercise. The study also tested HR and found out that resting HR was high in AF patients.

In conclusion, the current trends in cardiopulmonary stress testing by comparison of AF and non-AF, it is right to say that AF is independently linked to mortality and peak intolerance exercises of HFpEF patients. Therefore, by implementing individualized medication strategy by use of CPX on evaluating the hemodynamics and physiologic consequences of AF patients, we can be capable of recognizing individuals who can take advantage of the strategy of rhythm control.  This mostly applies if the main offender for the capacity of worse exercise is AF.

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