Invasive Cardiopulmonary Exercise Testing ProgramiCPET Program | Michael Risbano, MD, MA
Mission Statement / Aim
The Invasive Cardiopulmonary Exercise Testing Program at UPMC will provide multidisciplinary and comprehensive invasive cardiopulmonary exercise testing to study and diagnose all forms of abnormal pulmonary vascular responses to exercise for clinical and research purposes.
Vision for the Program
The iCPET Program is grounded in two fundamental principles.
Clinical Investigation. The backbone of this program is clinical investigation. The iCPET Program utilizes exercise as a stressor to investigate cardiopulmonary vascular and ventilator response to diagnose etiologies of dyspnea on exertion and exertional fatigue.
Research. Research investigation is a strong component of this program. Specific disease phenotypes will be identified for participation in research studies; patients will undergo deep phenotyping to evaluate the physiologic response to exercise as a stressor coupled with molecular analysis of acquired blood and tissue samples.
Invasive Cardiopulmonary Exercise Testing
The basis of exercise limitation can be investigated with Invasive Cardiopulmonary Exercise Testing.
iCPET at UPMC will entail breath-by-breath analysis of ventilatory gas exchange and invasive measurement of pulmonary vascular and cardiac function in association with upright cycle ergometer and ECG exercise testing.
Patients undergoing iCPET studies will have a pulmonary artery and radial artery catheter placed for the invasive measurements.
With the iCPET modality cardiac output, pulmonary artery pressures, multiple ventilatory indices, systemic pressures and ECG variables are simultaneously assessed during a progressive intensity exercise provocation.
iCPET adds significantly to the diagnostic sensitivity. In particular iCPET testing can delineate disease states related to pulmonary arterial, pulmonary venous, cardiac valvular, loading dynamics, autonomic, and skeletal muscle pathophysiologies that limit exercise capacity.
Indications for iCPET referrals and patient populations of interest
The majority of patients referred to the iCPET Program will have been seen by either a primary care physician or a subspecialty physician, including pulmonary, cardiology, rheumatology or geriatrics.
Patients will be referred for iCPET will include those with complaints of dyspnea on exertion or exercise fatigue that is not fully been explained by previous studies or the causative disease state is unclear.
Patients referred for testing may include those with dyspnea and histories of connective tissue disease (scleroderma in particular), diastolic dysfunction (HFpEF), pre-pulmonary or cardiac transplant, valvular heart disease (in particular pre-TAVR), post-pulmonary embolism, parenchymal lung disease (ILD, COPD, cystic fibrosis), sickle cell disease and pulmonary arterial hypertension.
Impact of the Invasive Cardiopulmonary Exercise Testing Program
Diagnosis of the etiology of exercise limitation or dyspnea on exertion not previously identified.
Identification of patients who may be eligible for clinical treatment trials or participation in investigational research trials.
Development of a plan for intervention that may include pharmacologic, surgical or cardiac/pulmonary rehabilitation therapies.