The new 9 panels display of data from cardiopulmonary exercise test, emphasizing holistic integrative multi-systemic functions

doi:10.12047/j.cjap.0123.2015.018

Abstract

Abstract: Objective: Since 1987, professor Wasserman displayed cardiopulmonary exercise test starting (CPET) data as 3 rows and 3 columns 9 panels plots. Although many changes and additions, there still are some important functional parameters were not shown in 9 panels. We want to display more. Methods: The 100 Hz sampling data of symptom-limited maximal limit CPET was used to calculate breath-by-breath data after per second cutting technique, and then to calculate the average value of 10 s data for graphic display. Results: In new 9 plots,panels ①~⑦use time for the "X" axis, oxygen uptake, carbon dioxide elimination, loaded power, heart rate, systolic blood pressure, diastolic blood pressure, heart rate pressure product, minute ventilation, respiratory exchange ratio, CO₂ elimination ventilatory efficiency, oxygen uptake ventilatory efficiency, oxygen pulse, ST segment level and ST segment slope at V₅ lead, tidal volume, respiratory rate, end tidal oxygen partial pressure, end tidal carbon dioxide partial pressure and oxygen saturation of 18 noninvasive parameters, and arterial oxygen partial pressure, arterial oxygen saturation, arterial partial pressure of carbon dioxide 3 blood gas parameters for the "Y" axis respectively. There are 3 vertical dashed lines represent dividing lines of the resting, warm-up, incremental power loading exercise and recovery period respectively. In addition, panels ① and ④have the horizontal dashed line represents the maximal oxygen uptake (red), oxygen uptake efficiency plateau (red) and the lowest value of carbon dioxide elimation ventilatory efficiency (blue) expected value respectively. Panel ⑧used heart rate and carbon dioxide elimination (as Y) against to oxygen uptake (as X); the "+" indicates intersection of the predicted maximum values of oxygen uptake and heart rate. Panel ⑨used tidal volume (as Y) against over minute ventilation (as X), vertical dashed line is the measured maximum ventilatory volume, the horizontal dashed lines were the inspiratory capacity and vital capacity respectively. Conclusion: New CPET 9 plots emphasizes on the integration of all circulatory,respiratory and metabolic etc functional parameters in human, and is conductive to optimization of clinical medical service and health management.

Key words: cardiopulmonary exercise testing, new 9 plots, cardiac function, pulmonary function, metabolic function, holistic integrative function

CLC Number:

R448

SUN Xing-guo. The new 9 panels display of data from cardiopulmonary exercise test, emphasizing holistic integrative multi-systemic functions[J]. CJAP, 2015, 31(4): 369-375.

References

[1] Wasserman K, Hansen J, Sue D, et al.Principles of exercise testing and interpretation[M]. 5th edition. Philadelphia:Lippincott Williams & Wilkins, 2011.
[2] Wasserman K, Stringer WW, Sun XG, et al.Circulatory coupling of external to muscle respiration during exercise. In Wasserman K ed. Cardiopulmonary exercise testing and cardiovascular health[M]. Armonk, NY:Futura Publishing Company, 2002: 1-25.
[3] 孙兴国. 整体整合生理学医学新理论体系: 人体功能一体化自主调控[J]. 中国循环杂志, 2013, 28(2): 88-92.
[4] 孙兴国. 服务于人的生命科学和医学工作者必须坚持整体观[J]. 中国应用生理学杂志,2015, 31(4): 289-294.
[5] 孙兴国. 生命整体调控新理论体系与心肺运动试验[J]. 医学与哲学(人文社会医学版), 2013, 34(3): 22-27.
[6] 孙兴国. 心肺运动在临床心血管病学的应用价值和前景[J].中华心血管病学杂志, 2014, 42(4): 347-351.
[7] 宁亮,孙兴国. 心肺运动试验在医学领域的临床应用[J].中国全科医学, 2013, 16(11): 3898-3902.
[8] Sun XG, Hansen JE, Oudiz RJ, et al.Exercise pathophysiology in patients with primary pulmonary hypertension[J]. Circulation, 2001, 104(4): 429-435.
[9] Sun XG, Hansen JE, Stringer WW.Oxygen uptake efficiency plateau best predicts early death in heart failure[J]. Chest, 2012, 141(5): 1284-1294.
[10] Stringer WW.Cardiopulmonary exercise testing: current applications[J]. Expert Rev Respir Med, 2010, 4(2): 179-188.
[11] Arena R, Sietsema KE.Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease[J]. Circulation, 2011, 123(6): 668-680.
[12] Wasserman K, Hansen JE, Sue DY, et al.Principles of Exercise Testing and Interpretation[M]. Lea & Febiger (Philadelphia), 1st ed. 1987, 400.
[13] Wasserman K, Hansen JE, Sue DY, et al.Principles of exercise testing and interpretation[M]. 2nd ed, Philadelphia: Lea & Febiger, 1994: 479.
[14] Wasserman K, Hansen JE, Sue DY, et al.Principles of exercise testing and interpretation: including pathophysiology and clinical applications[M]. 3rd ed, Philadelphia: Lippincott Williams & Wilkins, 1999, 556.
[15] Wasserman K, Hansen JE, Sue DY, et al.Principles of exercise testing and interpretation: including pathophysiology and clinical applications[M]. 4th ed. 2005. Philadelphia: Lippincott Williams & Wilkins, 2005.
[16] Sun XG, Hansen JE, Oudiz RJ, et al.Gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension[J]. Circulation, 2002, 105(1): 54-60.
[17] Wasserman K, Sun XG, Hansen JE.Effect of biventricular pacing on the exercise pathophysiology of heart failure[J]. Chest, 2007, 132(1): 250-261.
[18] Sun XG, Hansen JE, Beshai JF, et al.Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure[J]. J Am Coll Cardiol, 2010, 55(17): 1814-1823.
[19] Sun XG, Hansen JE, Stringer WW.Oxygen uptake efficiency plateau (OUEP): Physiology and reference value[J]. Eur J Appl Physiol,. 2012, 112(3): 919-928.
[20] Sun XG, Hansen JE, Garatachea N, et al.Ventilatory efficiency during exercise in healthy subjects[J]. Am J Respir Crit Care Med, 2002, 166(11): 1343-1348.
[21] 孙兴国,王桂芝,吕婧,等. 摄氧和二氧化碳排出通气效率是反映循环功能的指标[J]. 中华心血管病学杂志,2014, 42(12): 1022-1028.
[22] 卢志南,黄洁,孙兴国,等. 终末期慢性心衰患者运动中摄氧通气效能指标的临床应用[J]. 中华心血管病学杂志, 2015, 43(1): 44-40.
[23] 卢志南,孙兴国,胡盛寿,等. 心肺运动试验与NT-proBNP和超声心动图评估慢性心衰患者的心功能[J]. 中华心血管病学杂志, 2015, 43(3): 206-211.
[24] 孙兴国,胡大一. 心肺运动试验的实验室和设备要求及其临床实施难点的质量控制[J]. 中华心血管病学杂志,2014,42(10): 817-821.
[25] Huszczuk A, Whipp BJ, Wasserman K.A respiratory gas exchange simulator for routine calibration in metabolic studies[J]. Eur Respir J, 1990, 3(4): 465-468.
[26] Sun XG, Hansen JE, Oudiz R, et al.Heart rate (HR)-oxygen uptake (vo2) hysteresis during incremental exercise and recovery in primary pulmonary hypertension (pph)[J]. Am J Respir Crit Care Med, 2002, 165: A573.
[27] Garatachea N, Sun XG, Hansen JE, et al.Difference between exercise and recovery heart rate at iso-VO₂ in athletes[C]. The 2^nd European federation on Sports Medicine Congress; and The IX Congress FEMEDE, Oviedo , 2001: 14-17.
[28] Metra M, Cas LD, Panina G, et al.Exercise hyperventilation chronic congestive heart failure, and its relation to functional capacity and hemodynamics[J]. Am J Cardiol, 1992, 70: 622-628.
[29] Arena R, Humphrey R.Comparison of ventilatory expired gas parameters used to predict hospitalization in patients with heart failure[J]. Am Heart J, 2002, 143: 427-432.
[30] Arena R, Myers J, Hsu L, et al.The minute ventilation/carbon dioxide production slope is prognostically superior to the oxygen uptake efficiency slope[J]. J Cardiac Failure, 2007, 13: 462-469.
[31] Myers J, Arena R, Oliveira RB, et al.The Lowest VE/VCO2 ratio during exercise as a predictor of outcomes in patients with heart failure[J]. J Cardiac Failure, 2009, 15: 756-762.