Chest
Clinical Investigations: ExerciseBreathing Reserve at the Lactate Threshold to Differentiate a Pulmonary Mechanical From Cardiovascular Limit to Exercise
Section snippets
Study Population
Consecutive maximum incremental cardiopulmonary exercise tests performed at the Massachusetts General Hospital (MGH) from 1991 to 1995, in which arterial blood was sampled during exercise, were evaluated. From this population, three groups were identified based on the type of exercise limit reached: normal (NL), PML, and cardiovascular limit (CVL). NL subjects consisted of individuals with suspected cardiopulmonary disease, but with a >80% predicted, maximum >80%
RESULTS
The demographic characteristics of the three groups are shown in Table 1. There was no significant difference in age or Hb among groups. Weight was reduced in the PML group. There was an equal sex distribution in PML and CVL groups, but there was a male predominance in the NL group, β-Adrenergic blockers were being taken by nine (31%) CVL patients, one (12%) NL subject, and none in the PML group.
The PML group demonstrated a marked reduction in FEV1, with hyperinflation and severely depressed
DISCUSSION
Exertional intolerance is a common but exceedingly nonspecific feature of pulmonary and cardiovascular disease. This has provided incentive for the development of cardiopulmonary exercise testing diagnostic algorithms that can be used to identify the limiting organ system in patients with concurrent disease of the lungs and heart1,2,20 and to direct therapy. Most variables thought to be useful in assessing an organ's functional reserve are measured at peak exercise with the implicit assumption
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Cited by (31)
Cardiopulmonary Exercise Testing in Pulmonary Vascular Disease
2021, Encyclopedia of Respiratory Medicine, Second EditionOxygen Uptake Efficiency Slope and Breathing Reserve, Not Anaerobic Threshold, Discriminate Between Patients With Cardiovascular Disease Over Chronic Obstructive Pulmonary Disease
2016, JACC: Heart FailureCitation Excerpt :These studies are the foundation of what has become a firmly held belief—namely that VO2 at AT reflects cardiac function. Very few CPX studies performed on patients with COPD report the VO2 at AT however Medoff et al. (8) found no difference between COPD and heart failure patients with similar exercise capacities, consistent with our findings. We showed that VO2 at AT (as a percent predicted peak VO2) has poor discriminant ability between the disease groups, and only showed moderate discrimination between healthy adults and the 2 groups.
Exercise-induced bronchoconstriction in school-aged children who had chronic lung disease in infancy
2013, Journal of PediatricsPreoperative cardiac evaluation: Mechanisms, assessment, and reduction of risk
2005, Thoracic Surgery ClinicsUtility of the Breathing Reserve Index at the Anaerobic Threshold in Determining Ventilatory-Limited Exercise in Adult Cystic Fibrosis Patients
2003, ChestCitation Excerpt :There are a number of potential limitations to this study, most relating to the manner in which the exercise study was performed, particularly the defining thresholds used. In contrast to the study of Medoff et al,5 who determined the lactate threshold invasively via measurement of arterial blood lactate levels, the present study used the noninvasive V-slope method.10 In lung disease patients, values obtained by the V-slope method correlate very well with measures obtained invasively,22 including patients with CF.23 Recent studies24 have shown that noninvasive assessment of the AT in CF patients is accurate and reproducible across a wide range of pulmonary function.
Supported by a research fellowship of The Will Rogers Institute (Dr. Oelberg) and an AHA Grant-in-Aid (Dr. Systrom). Manuscript received July 9, 1997; revision accepted September 16, 1997.