Combining cardiopulmonary exercise testing and echocardiography for the assessment and management of patients with heart disease

Patients are often assessed at rest whilst symptoms are often not apparent until systolic or diastolic dysfunction are far advanced. There is relatively poor correlation between measures of resting heart function and symptomatic limitation. Symptoms often appear when patients are exerting themselves. Evaluating patients during exercise provides a more complete overall description of a patient's overall wellbeing. An objective measure of exercise tolerance can be done using cardiopulmonary exercise testing (CPET). CPET has shown to be a valued assessment when evaluating prognosis, risk assessment, effect of treatments and provides an objective assessment of a patient exercise tolerance. It is possible to combine CPET with echocardiography. Echocardiography is a powerful, non-invasive, safe, and painless technique and is one of the most important and extensively used diagnostic tests performed in cardiology and routinely used in the diagnosis, management and follow-up in patients with cardiac disease. Performing echocardiography during stress is a useful and non-invasive assessment. Combining CPET and stress echocardiography techniques offers a unique, quick, complete and objective clinical assessment which will provide superior information regarding a patient’s prognosis and diagnosis. It is straightforward to incorporate a CPET procedure into a standard stress echocardiogram protocol. It is relatively simple and safe, and it is a logical step for CPET to be incorporated more widely in clinical practice. Combining both techniques can provide invaluable information regarding patients’ management. However the full potential of this new and exciting assessment is yet to be investigated.

Eastbourne District General Hospital

Dr Guy Lloyd

Adviser: Dr Nik Patel