Advanced Cardiopulmonary Exercise Testing ProgramACPET Program | Michael Risbano, MD, MA
Mission Statement / Aim
The Advanced 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 ACPET Program is grounded in two fundamental principles.
Clinical Investigation. The backbone of this program is clinical investigation. The ACPET 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.
Advanced Cardiopulmonary Exercise Testing
The basis of exercise limitation can be investigated with Advanced Cardiopulmonary Exercise Testing.
ACPET 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 ACPET studies will have a pulmonary artery and radial artery catheter placed for the invasive measurements.
With the ACPET modality cardiac output, pulmonary artery pressures, multiple ventilatory indices, systemic pressures and ECG variables are simultaneously assessed during a progressive intensity exercise provocation.
ACPET adds significantly to the diagnostic sensitivity. In particular ACPET 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 ACPET referrals and patient populations of interest
The majority of patients referred to the ACPET 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 ACPET 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 Advanced 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.
In the News
ACPET Program Helps Pinpoint Source of Breathing Problems
A new program at UPMC is now helping patients find out what’s causing their undiagnosed breathing troubles, and making sure they get the right treatment…
Read more at KDKA: New Program Helping Doctors Pinpoint Source Of Patients’ Breathing Problems
Check for underlying pulmonary vascular disease in patients with a very low diffusion of the lungs for carbon monoxide (DLco%), as this may signify the presence of exercise pulmonary hypertension (ePH), according to results presented in Washington, DC, in late May at the American Thoracic Society 2017 International Conference.