La integración de la prueba de esfuerzo cardiopulmonar y la ecocardiografía en la práctica clínica: artículo de revisión.
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https://doi.org/10.37615/retic.v7n3a3Palabras clave:
prueba de ejercicio cardiopulmonar, ecocardiograma de ejercicio, insuficiencia cardiaca, disneaResumen
La integración de la prueba de esfuerzo cardiopulmonar (CPET) con la ecocardiografía de estrés (Echo) aporta una evaluación integral de la función cardiopulmonar, facilitando la comprensión de la fisiopatología de la intolerancia al ejercicio en pacientes con cardiopatías. Este artículo revisa las principales variables pronósticas y diagnósticas obtenidas de la CPET-Echo, y destaca su aplicación en insuficiencia cardíaca, disnea de origen incierto y otros trastornos. La combinación de CPET con ecocardiografía de esfuerzo optimiza la identificación de los mecanismos limitantes del ejercicio, permitiendo una estratificación de riesgo más precisa y la personalización de estrategias terapéuticas en distintos contextos clínicos.
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Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R, Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J; European Association for Cardiovascular Prevention & Rehabilitation; American Heart Association. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012 Oct 30;126(18):2261-74. doi: 10.1161/CIR.0b013e31826fb946. Epub 2012 Sep 5. PMID: 22952317; PMCID: PMC4777325 DOI: https://doi.org/10.1161/CIR.0b013e31826fb946
Verwerft J, Soens L, Wynants J, Meysman M, Jogani S, Plein D, Stroobants S, Herbots L, Verbrugge FH. Heart failure with preserved ejection fraction: relevance of a dedicated dyspnoea clinic. Eur Heart J. 2023 May 1;44(17):1544-1556. doi: 10.1093/eurheartj/ehad141. PMID: 36924194. DOI: https://doi.org/10.1093/eurheartj/ehad141
Vannini L, Quijada-Fumero A, Martín MPR, Pina NC, Afonso JSH. Cardiopulmonary exercise test with stress echocardiography in COVID-19 survivors at 6 months follow-up. Eur J Intern Med. 2021 Dec;94:101-104. doi: 10.1016/j.ejim.2021.10.004. Epub 2021 Oct 11. PMID: 34654589; PMCID: PMC8502682 DOI: https://doi.org/10.1016/j.ejim.2021.10.004
Joseph P, Arevalo C, Oliveira RKF, Faria-Urbina M, Felsenstein D, Oaklander AL, Systrom DM. Insights From Invasive Cardiopulmonary Exercise Testing of Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Chest. 2021 Aug;160(2):642-651. doi: 10.1016/j.chest.2021.01.082. Epub 2021 Feb 10. PMID: 33577778; PMCID: PMC8727854. DOI: https://doi.org/10.1016/j.chest.2021.01.082
Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, Haskell WL, Kaminsky LA, Levine BD, Lavie CJ, Myers J, Niebauer J, Sallis R, Sawada SS, Sui X, Wisløff U; American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Cardiovascular and Stroke Nursing; Council on Functional Genomics and Translational Biology; Stroke Council. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation. 2016 Dec 13;134(24):e653-e699. doi: 10.1161/CIR.0000000000000461. Epub 2016 Nov 21. PMID: 27881567 DOI: https://doi.org/10.1161/CIR.0000000000000461
Imboden MT, Harber MP, Whaley MH, Finch WH, Bishop DL, Kaminsky LA. Cardiorespiratory Fitness and Mortality in Healthy Men and Women. J Am Coll Cardiol. 2018 Nov 6;72(19):2283-2292. doi: 10.1016/j.jacc.2018.08.2166. PMID: 30384883. DOI: https://doi.org/10.1016/j.jacc.2018.08.2166
Franco C. Rol de las imágenes cardíacas en la indicación, seguimiento y resultado de la rehabilitación cardiovascular. En Wolf, Venegas, Franco, Peidro. Imágenes Cardiacas en Cardiología del Ejercicio. Distribuna 2024
Wiecha S, Kasiak PS, Cieśliński I, Takken T, Palka T, Knechtle B, Nikolaidis PΤ, Małek ŁA, Postuła M, Mamcarz A, Śliż D. External validation of VO2max prediction models based on recreational and elite endurance athletes. PLoS One. 2023 Jan 25;18(1):e0280897. doi: 10.1371/journal.pone.0280897. PMID: 36696387; PMCID: PMC9876283. DOI: https://doi.org/10.1371/journal.pone.0280897
Glaab, T., Taube, C. Practical guide to cardiopulmonary exercise testing in adults. Respir Res 23, 9 (2022). https://doi.org/10.1186/s12931-021-01895-6 DOI: https://doi.org/10.1186/s12931-021-01895-6
Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis. 1984 Feb;129(2 Pt 2):S49-55. doi: 10.1164/arrd.1984.129.2P2.S49. PMID: 6421218. DOI: https://doi.org/10.1164/arrd.1984.129.2P2.S49
O'Neill JO, Young JB, Pothier CE, Lauer MS. Peak oxygen consumption as a predictor of death in patients with heart failure receiving beta-blockers. Circulation. 2005 May 10;111(18):2313-8. http://doi.org/10.1161/01.CIR.0000164270.72123.18
Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J. 2004 Feb;147(2):354-60. doi: 10.1016/j.ahj.2003.07.014. PMID: 14760336. DOI: https://doi.org/10.1016/j.ahj.2003.07.014
Guazzi M, Raimondo R, Vicenzi M, Arena R, Proserpio C, Sarzi Braga S, Pedretti R. Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients. J Am Coll Cardiol. 2007 Jul 24;50(4):299-308. doi: 10.1016/j.jacc.2007.03.042. Epub 2007 Jul 12. PMID: 17659196. DOI: https://doi.org/10.1016/j.jacc.2007.03.042
Hollenberg M, Tager IB. Oxygen uptake efficiency slope: an index of exercise performance and cardiopulmonary reserve requiring only submaximal exercise. J Am Coll Cardiol. 2000 Jul;36(1):194-201. doi: 10.1016/s0735-1097(00)00691-4. PMID: 10898434. DOI: https://doi.org/10.1016/S0735-1097(00)00691-4
Chiang WJ, Lee JT, Hung SY, Hsu PC, Chou CL. Prognostic Value of Body Surface Area-Adjusted Oxygen Uptake Efficiency Slope in Heart Failure Patients. Acta Cardiol Sin. 2024 May;40(3):322-330. doi: 10.6515/ACS.202405_40(3).20240105A. PMID: 38779165; PMCID: PMC11106627.
Pugliese, N. R., Fabiani, I., Santini, C., Rovai, I., Pedrinelli, R., Natali, A., & Dini, F. L. (2019). Value of combined cardiopulmonary and echocardiography stress test to characterize the haemodynamic and metabolic responses of patients with heart failure and mid-range ejection fraction. European Heart Journal - Cardiovascular Imaging. doi:10.1093/ehjci/jez014 DOI: https://doi.org/10.1093/ehjci/jez014
Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, Collins E, Fletcher G; American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Nursing. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007 Jul 17;116(3):329-43. doi: 10.1161/CIRCULATIONAHA.106.184461. Epub 2007 Jun 18. PMID: 17576872. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.184461
Myers J, Gullestad L, Vagelos R, Do D, Bellin D, Ross H, Fowler MB. Cardiopulmonary exercise testing and prognosis in severe heart failure: 14 mL/kg/min revisited. Am Heart J. 2000 Jan;139(1 Pt 1):78-84. doi: 10.1016/s0002-8703(00)90312-0. PMID: 10618566 DOI: https://doi.org/10.1016/S0002-8703(00)90312-0
O'Neill JO, Young JB, Pothier CE, Lauer MS. Peak oxygen consumption as a predictor of death in patients with heart failure receiving beta-blockers. Circulation. 2005 May 10;111(18):2313-8. doi: 10.1161/01.CIR.0000164270.72123.18. Epub 2005 May 2. PMID: 15867168. DOI: https://doi.org/10.1161/01.CIR.0000164270.72123.18
Guazzi, M., Myers, J., Abella, J., Peberdy, M. A., Bensimhon, D., Chase, P., & Arena, R. (2008). The added prognostic value of ventilatory efficiency to the Weber classification system in patients with heart failure. International Journal of Cardiology, 129(1), 86–92. doi:10.1016/j.ijcard.2007.05.028 DOI: https://doi.org/10.1016/j.ijcard.2007.05.028
Sun XG, Hansen JE, Beshai JF, Wasserman K. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure. J Am Coll Cardiol. 2010 Apr 27;55(17):1814-23. doi: 10.1016/j.jacc.2009.10.075. PMID: 20413031 DOI: https://doi.org/10.1016/j.jacc.2009.10.075
American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003 Jan 15;167(2):211-77. doi: 10.1164/rccm.167.2.211. Erratum in: Am J Respir Crit Care Med. 2003 May 15;1451-2. PMID: 12524257. DOI: https://doi.org/10.1164/rccm.167.2.211
Pollock M, Roa J, Benditt J, Celli B. Estimation of ventilatory reserve by stair climbing. A study in patients with chronic airflow obstruction. Chest. 1993 Nov;104(5):1378-83. doi: 10.1378/chest.104.5.1378. PMID: 8222791.)(Glaab, T., Taube, C. Practical guide to cardiopulmonary exercise testing in adults. Respir Res 23, 9 (2022). https://doi.org/10.1186/s12931-021-01895-6 DOI: https://doi.org/10.1378/chest.104.5.1378
Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, Cooper BG, Culver B, Derom E, Hall GL, Hallstrand TS, Leuppi JD, MacIntyre N, McCormack M, Rosenfeld M, Swenson ER. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022 Jul 13;60(1):2101499. doi: 10.1183/13993003.01499-2021. PMID: 34949706. DOI: https://doi.org/10.1183/13993003.01499-2021
Picano E, Ciampi Q, Wierzbowska-Drabik K, Urluescu ML, Morrone D, Carpeggiani C. The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol. Cardiovasc Ultrasound. 2018 Oct 2;16(1):22. doi: 10.1186/s12947-018-0141-z. PMID: 30285774; PMCID: PMC6167852. DOI: https://doi.org/10.1186/s12947-018-0141-z
Vignati C, Cattadori G. Measuring Cardiac Output during Cardiopulmonary Exercise Testing. Ann Am Thorac Soc. 2017 Jul;14(Supplement_1):S48-S52. doi: 10.1513/AnnalsATS.201611-852FR. PMID: 28441030. DOI: https://doi.org/10.1513/AnnalsATS.201611-852FR
Maron BA, Cockrill BA, Waxman AB, Systrom DM. The invasive cardiopulmonary exercise test. Circulation. 2013 Mar 12;127(10):1157-64. doi: 10.1161/CIRCULATIONAHA.112.104463. PMID: 23479667 DOI: https://doi.org/10.1161/CIRCULATIONAHA.112.104463
Verwerft J, Bertrand PB, Claessen G, Herbots L, Verbrugge FH. Cardiopulmonary Exercise Testing With Simultaneous Echocardiography: Blueprints of a Dyspnea Clinic for Suspected HFpEF. JACC Heart Fail. 2023 Feb;11(2):243-249. doi: 10.1016/j.jchf.2022.11.004. PMID: 36754531. DOI: https://doi.org/10.1016/j.jchf.2022.11.004
Faulkner JA, Heigenhauser GF, Schork MA: The cardiac out-put-oxygen uptake relationship of men during graded bicycleergometry. Med Sci Sports Exerc 1977;9:148-154
Koike A, Hiroe M, Adachi H, Yajima T, Itoh H, Takamoto T, Taniguchi K, Marumo F. Cardiac output-O2 uptake relation during incremental exercise in patients with previous myocardial infarction. Circulation. 1992 May;85(5):1713-9. doi: 10.1161/01.cir.85.5.1713. PMID: 1572029 DOI: https://doi.org/10.1161/01.CIR.85.5.1713
Jain CC, Borlaug BA. Performance and Interpretation of Invasive Hemodynamic Exercise Testing. Chest. 2020 Nov;158(5):2119-2129. DOI: 10.1016/j.chest.2020.05.552. PMID: 32473950; PMCID: PMC7674988 DOI: https://doi.org/10.1016/j.chest.2020.05.552
Shimiaie J, Sherez J, Aviram G, Megidish R, Viskin S, Halkin A, Ingbir M, Nesher N, Biner S, Keren G, Topilsky Y. Determinants of Effort Intolerance in Patients With Heart Failure: Combined Echocardiography and Cardiopulmonary Stress Protocol. JACC Heart Fail. 2015 Oct;3(10):803-14. doi: 10.1016/j.jchf.2015.05.010. PMID: 26449998 DOI: https://doi.org/10.1016/j.jchf.2015.05.010
Pugliese NR, De Biase N, Conte L, Gargani L, Mazzola M, Fabiani I, Natali A, Dini FL, Frumento P, Rosada J, Taddei S, Borlaug BA, Masi S. Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing. J Am Soc Echocardiogr. 2021 Jan;34(1):38-50. doi: 10.1016/j.echo.2020.08.015. Epub 2020 Oct 6. PMID: 33036818. DOI: https://doi.org/10.1016/j.echo.2020.08.015
Martens P, Herbots L, Timmermans P, Verbrugge FH, Dendale P, Borlaug BA, Verwerft J. Cardiopulmonary Exercise Testing with Echocardiography to Identify Mechanisms of Unexplained Dyspnea. J Cardiovasc Transl Res. 2022 Feb;15(1):116-130. doi: 10.1007/s12265-021-10142-8. Epub 2021 Jun 10. PMID: 34110608. DOI: https://doi.org/10.1007/s12265-021-10142-8
Baratto C, Caravita S, Faini A, Perego GB, Senni M, Badano LP, Parati G. Impact of COVID-19 on exercise pathophysiology: a combined cardiopulmonary and echocardiographic exercise study. J Appl Physiol (1985). 2021 May 1;130(5):1470-1478. doi: 10.1152/japplphysiol.00710.2020. Epub 2021 Mar 25. PMID: 33764166; PMCID: PMC8143785. DOI: https://doi.org/10.1152/japplphysiol.00710.2020
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Derechos de autor 2024 Carlos Franco-Cruz, Jessica Mercedes, Verónica Gómez-Leiva
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