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Cardiology

Cardiopulmonary Exercise Testing

Educational Objective
To understand how to interpret the results of diagnostic tests and apply them clinically.

1 Credit CME

JAMA

Published Online: March 10, 2022

JAMA Diagnostic Test Interpretation

Article Information and Disclosures

Esther de Boer, MD, PhD¹;

Irina Petrache, MD^1,2;

Michael P. Mohning, MD^1,2

Author Affiliations

¹Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
²Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado

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A 33-year-old man with a history of intermittent asthma presented with 3 months of dyspnea on exertion, which developed approximately 2 weeks after infection with SARS-CoV-2. His acute COVID-19 symptoms resolved after 5 days and did not require hospitalization. At presentation, his physical examination findings were normal and peripheral oxygen saturation was 97% at rest. Laboratory testing, chest radiographic imaging, chest computed tomographic scan, echocardiography, and pulmonary function testing results were normal. To further evaluate his dyspnea on exertion, the patient underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer with arterial blood gas samples obtained from an indwelling radial artery catheter. Continuous 12-lead electrocardiogram (ECG) findings showed no evidence of arrythmia or ischemia, and the patient stopped exercise due to leg fatigue after 15 minutes. Select exercise data are presented in the Table and Figure.

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A 33-year-old man with a history of intermittent asthma presented with 3 months of dyspnea on exertion, which developed approximately 2 weeks after infection with SARS-CoV-2. His acute COVID-19 symptoms resolved after 5 days and did not require hospitalization. At presentation, his physical examination findings were normal and peripheral oxygen saturation was 97% at rest. Laboratory testing, chest radiographic imaging, chest computed tomographic scan, echocardiography, and pulmonary function testing results were normal. To further evaluate his dyspnea on exertion, the patient underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer with arterial blood gas samples obtained from an indwelling radial artery catheter. Continuous 12-lead electrocardiogram (ECG) findings showed no evidence of arrythmia or ischemia, and the patient stopped exercise due to leg fatigue after 15 minutes. Select exercise data are presented in the Table and Figure.

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Article Information

Corresponding Author: Michael P. Mohning, MD, National Jewish Health, 1400 Jackson St, Building G07a, Denver, CO 80206 (mohningm@njhealth.org).

Published Online: March 10, 2022. doi:10.1001/jama.2022.2037

Conflict of Interest Disclosures: Dr Petrache reported receiving personal fees from Allinaire and Ceramedix outside the submitted work. Dr Mohning reported receiving consulting fees from Diffusion Pharmaceuticals outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Petrache reported receipt of financial support from the Wollowick Chair in COPD Research.

Role of the Funder/Sponsor: The funder had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.

Additional Contribution: We thank Iñigo San-Millán, PhD (University of Colorado School of Medicine), for his contributions, including discussion and review of the manuscript. He did not receive compensation for his contributions. We also thank the patient for granting permission to publish this information.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.