The role of gas analysis with exercise testing.

Evaluation of exercise performance is an integral component of every medical history. Currently, it is accomplished by means of subjective history taking. Routine exercise testing adds very little information; however, the addition of gas analysis (or cardio pulmonary exercise [CPX] testing) provides the crucial objective assessment by analyzing breath-by-breath oxygen uptake, carbon dioxide production, and anaerobic threshold (AT). Cardiac and pulmonary causes can be reliably differentiated, e.g., cardiac patients cross AT and attain VO2max, use less than 50% of maximal voluntary ventilation (MVV) at peak exercise, and do not develop desaturation. Pulmonary patients, on the contrary, fail to cross AT or achieve VO2max, utilize more than 70% of MVV at peak exercise, and develop arterial desaturation. In the current cost-conscious health care system, CPX proves to be a better cost-effective test because it is objective and more directly targeted to the issues than the conventional exercise test. CPX provides an important link between the disease process and its effect on exercise performance, which is crucial to a comprehensive clinical evaluation, diagnosis, prognosis, exercise prescription, and follow-up after medical or surgical intervention in patients with various diseases causing cardiopulmonary dysfunction.