EACPR/AHA Scientific Statement Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations WRITING COMMITTEE EACPR: Marco Guazzi, Co-Chair, 1 * Volker Adams, 2 Viviane Conraads, 3 Martin Halle, 4 Alessandro Mezzani, 5 Luc Vanhees 6 AHA: Ross Arena, Co-Chair, 7 Gerald F. Fletcher, 8 Daniel E. Forman, 9 Dalane W. Kitzman, 10 Carl J. Lavie, 11,12 Jonathan Myers 13 Table of Contents Abbreviations ................................2262 Introduction ..................................2262 What Is Cardiopulmonary Exercise Testing?.........2262 Defining Key Cardiopulmonary Exercise Testing Variables ..................................2263 Universal Cardiopulmonary Exercise Testing Reporting Form .....................................2266 Unique Condition-Related Cardiopulmonary Exercise Testing Variables According to Test Indication.....2266 Systolic Heart Failure ........................2266 Heart Failure With Preserved Ejection Fraction and Congenital Heart Disease ...................2267 Hypertrophic Cardiomyopathy..................2268 Unexplained Exertional Dyspnea................2268 Suspected or Confirmed Pulmonary Arterial Hypertension or Secondary Pulmonary Hypertension.........2269 Confirmed Chronic Obstructive Pulmonary Disease or Interstitial Lung Disease ...........2269 Suspected Myocardial Ischemia.................2269 Suspected Mitochondrial Myopathy .............2270 Directions for Future Research ...................2270 Conclusions ..................................2270 Disclosures ..................................2271 Appendixes 1: Universal CPX Reporting Form...............2271A 2: Prognostic and Diagnostic Stratification for Patients With Heart Failure ..................2271B 3: Prognostic and Diagnostic Stratification for Patients With Confirmed or Suspected Hypertrophic Cardiomyopathy ................2271C 4: Diagnostic Stratification for Patients With Unexplained Dyspnea ......................2271D 1 Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, P.za Malan, 2, 20097, Milan, Italy; 2 Department of Cardiology, University Leipzig–Heart Center Leipzig, Leipzig, Germany; 3 Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; 4 Department of Prevention and Sports Medicine, Technische Universität Mu¨nchen, Munich, Germany; Munich Heart Association, Munich, Germany; 5 Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, S. Maugeri Foundation IRCCS, Scientific Institute of Veruno, Veruno (NO), Italy; 6 Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven (University of Leuven), Leuven, Belgium; 7 Department of Orthopaedics and Rehabilitation – Division of Physical Therapy and Department of Internal Medicine – Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, NM, USA; 8 Mayo Clinic College of Medicine, Jacksonville, FL, USA; 9 Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 10 Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; 11 Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA; 12 Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA; and 13 Division of Cardiology, VA Palo Alto Health Care System, Stanford University, Palo Alto, CA, USA. *Corresponding author. Tel: 39 02 52774966, Fax: 39 02 52774966, E-mail: marco.guazzi@unimi.it. The European Society of Cardiology/European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This document was approved by the European Society of Cardiology/European Association for Cardiovascular Prevention & Rehabilitation June 27, 2012, and by the American Heart Association Science Advisory and Coordinating Committee June 5, 2012. The American Heart Association requests that this document be cited as follows: Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R, Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126:2261–2274. This article has been copublished in the European Heart Journal. Copies: This document is available on the World Wide Web sites of the European Society of Cardiology (www.escardio.org) and the American Heart Association (my.americanheart.org). A copy of the document is available at http://my.americanheart.org/statements by selecting either the “By Topic” link or the “By Publication Date” link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the “Policies and Development” link. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright- Permission-Guidelines_UCM_300404_Article.jsp. A link to the “Copyright Permissions Request Form” appears on the right side of the page. (Circulation. 2012;126:2261-2274.) © 2012 by the European Society of Cardiology and American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0b013e31826fb946 2261 Downloaded from http://ahajournals.org by on June 6, 2020