Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, Istituti Clinici Scientifici Maugeri Spa Società Benefit, Scientific Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico, Veruno, Novara, Italy.
Ann Am Thorac Soc. 2017 Jul;14(Supplement_1):S3-S11. doi: 10.1513/AnnalsATS.201612-997FR.
Cardiopulmonary exercise testing adds measurement of ventilation and volume of oxygen uptake and exhaled carbon dioxide to routine physiological and performance parameters obtainable from conventional exercise testing, furnishing an all-around vision of the systems involved in both oxygen transport from air to mitochondria and its use during exercise. Peculiarities of cardiopulmonary exercise testing methodology are the use of ramp protocols and calibration procedures for flow meters and gas analyzers. Among the several parameters provided by this technique, peak oxygen uptake, first and second ventilatory thresholds, respiratory exchange ratio, oxygen pulse, slope of ventilation divided by exhaled carbon dioxide relationship, exercise oscillatory ventilation, circulatory power, and partial pressure of end-tidal carbon dioxide are among the most relevant in the clinical setting. The choice of parameters to be considered will depend on the indication to cardiopulmonary exercise testing in the individual subject or patient, namely, exercise tolerance assessment, prognostic stratification, training prescription, treatment efficacy evaluation, diagnosis of causes of unexplained exercise tolerance reduction, or exercise (patho)physiology evaluation for research purposes. Overall, cardiopulmonary exercise testing is a methodology now widely available and supported by sound scientific evidence. Despite this, its potential still remains largely underused. Strong efforts and future investigations are needed to address these issues and further promote the use of cardiopulmonary exercise testing in the clinical and research setting.
心肺运动试验除了常规运动试验中可获得的生理和运动表现参数外，还增加了通气和摄氧量以及呼出二氧化碳量的测量，为空气到线粒体的氧气输送及其在运动过程中的利用这两个系统提供了全面的视角。心肺运动试验方法学的特点是使用斜坡方案和流量表以及气体分析仪的校准程序。在该技术提供的多个参数中，峰值摄氧量、第一和第二通气阈值、呼吸交换率、氧脉搏、通气除以呼出二氧化碳关系的斜率、运动性振荡通气、循环功率和末呼气二氧化碳分压在临床环境中是最相关的参数之一。选择要考虑的参数将取决于个体或患者进行心肺运动试验的指征，即运动耐量评估、预后分层、训练处方、治疗效果评估、无法解释的运动耐量降低的原因诊断，或出于研究目的的运动（病理）生理学评估。总的来说，心肺运动试验是一种现在广泛可用且有可靠科学证据支持的方法。尽管如此，其潜力在很大程度上仍未得到充分利用。需要做出巨大努力和未来的研究来解决这些问题，并进一步促进心肺运动试验在临床和研究环境中的应用。
