Diagnostic role of cardiopulmonary exercise testing in patients with sarcoidosis
https://doi.org/10.18093/0869-0189-2018-28-6-736-745
Abstract
A review of protocols and staging of cardiopulmonary exercise testing (CPET) used in clinical practice is done in the article. CPET is proposed to assess the functional status and to diagnose early reserve abnormalities in patients with sarcoidosis as far as functional tests at rest are mostly insufficient in sarcoidosis. Physiological processes at anaerobic threshold at peak exercise are described in the article. The authors reviewed current approach to terminology and determination of anaerobic threshold, methods for calculation of cut-off points and their clinical role. Diagnostic values of CPET parameters, such as maximal and peak oxygen uptake and oxygen consumption ratio, parameters of gas exchange and ventilation, such as ventilatory equivalent, breathing reserve, alveolar-arterial gradient in oxygen, and ventilation-perfusion ratio, in patients with sarcoidosis were also discussed.
About the Authors
L. B. Postnikova
Nizhniy Novgorod State City Teaching Hospital No.38
Russian Federation
Competing Interests: No conflict of interest
Russian Federation
Larisa B. Postnikova - Doctor of Medicine, Associate Professor, Chief Pneumologist of Healthcare Ministry of Nizhniy Novgorod region.
Ul. Chernyshevskogo 22, Nizhniy Novgorod, 603000, tel.: (910) 390-64-37
Competing Interests: No conflict of interest
A. L. Gudim
Nizhniy Novgorod State City Teaching Hospital No.38
Russian Federation
Competing Interests: No conflict of interest
Russian Federation
Andrey L. Gudim - therapeutist.
Ul. Chernyshevskogo 22, Nizhniy Novgorod, 603000, tel.: (831) 434-20-20Competing Interests: No conflict of interest
V. A. Kostrov
Nizhniy Novgorod State City Teaching Hospital No.38
Russian Federation
Competing Interests: No conflict of interest
Russian Federation
Vladimir A. Kostrov - Candidate of Medicine, Associate Professor, pulmonologist.
Ul. Chernyshevskogo 22, Nizhniy Novgorod, 603000, tel.: (831) 434-20-20
Competing Interests: No conflict of interest
I. A. Dorovskoy
Nizhniy Novgorod State City Teaching Hospital No.38
Russian Federation
Competing Interests: No conflict of interest
Russian Federation
Ivan A. Dorovskoy - therapeutist.
Ul. Chernyshevskogo 22, Nizhniy Novgorod, 603000, tel.: (831) 434-20-20
Competing Interests: No conflict of interest
S. K. Soodayeva
Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Russian Federation
Competing Interests: No conflict of interest
Russian Federation
Svetlana K. Soodaeva - Doctor of Medicine, Professor, Head of Laboratory of Clinical and Experimental Biophysics, Federal Pulmonology Research Institute.
Orekhovyy bul'var 28, Moscow, 115682, tel.: (495) 465-52-64
Competing Interests: No conflict of interest
N. A. Popova
Sudzha Central Regional Hospital of Kursk region
Russian Federation
Competing Interests: No conflict of interest
Russian Federation
Natal’ya A. Popova - therapeutist, Sudzha Central Regional Hospital of Kursk region
Ul. Bol’nichnaya 1, Goncharovka, Sudzha area, Kursk region, 307800, tel.: (908) 121-82-50
Competing Interests: No conflict of interest
References
1. Chuchalin A.G., Avdeev S.N., Aisanov Z.R. et al. Sarcoidosis. Federal Clinical Guidelines. Moscow, Russian Respiratory Society; 2016. Available at: http://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii (in Russian).
2. Cozier Y.C. Assessing the worldwide epidemiology of sarcoidosis: challenges and future directions. Eur. Resp. J. 2016; 48 (6): 1545−1548. DOI: 10.1183/13993003.01819-2016.
3. Morimoto T., Azuma A., Abe S. et al. Epidemiology of sarcoidosis in Japan. Eur. Respir. J. 2008; 31 (2): 372−379. DOI: 10.1183/09031936.00075307.
4. Baughman R.P., Field S., Costabel U. et al. Sarcoidosis in America. Analysis based on health care use. Ann. Am. Thorac. Soc. 2016; 13 (8): 1244−1252. DOI: 10.1513/AnnalsATS.201511-760OC.
5. Vizel’ A.A., Vizel’ I.Yu., Amirov N.B. Epidemiology of sarcoidosis in Russian Federation. Vestnik sovremennoy klinicheskoy meditsiny. 2017; 5 (10): 66−73. DOI: 10.20969/VSKM.2017.10(5).66-73 (in Russian).
6. Postnikova L.B., Gudim A.L., Boldina M.V. et al. Clinical manifestations, diagnosis and treatment of pulmonary sarcoidosis at Nizhniy Novgorod. Vestnik sovremennoy klinicheskoy meditsiny. 2016; 9 (4): 44−51. DOI: 10.20969/VSKM.2016.9(4).44-51 (in Russian).
7. Baranova O.P., Il’kovich M.M., Speranskaya A.A. Challenge in diagnosis of pulmonary sarcoidosis. Prakticheskaya meditsina. 2011; 3 (51): 58−62 (in Russian).
8. Vizel’ I.Yu., Vizel’ A.A., Shaymuratov R.I. et al. Radiological, laboratory and functional parallels in intrathoracic sarcoidosis. Terapevticheskiy arkhiv. 2015; 87 (3): 48−52. DOI: 10.17116/terarkh201587348-52 (in Russian).
9. Savushkina O.I., Antipushina D.N., Zaytsev A.A. A role of complex testing of respiratory function for diagnosing ventilation and diffusion abnormalities in patients with [pulmonary sarcoidosis in a multi-profile military hospital. Pul’monologiya. 2015; 25 (1): 82−85. DOI: 10.18093/0869-0189-2015-25-1-82-85 (in Russian).
10. Akkoca Ö., Celik G., Ulger F. et al. Exercise capacity in sarcoidosis. Study of 29 patients. Med. Clin. (Barc.). 2005; 124 (18): 686−689. DOI: 10.1157/13075090.
11. Postnikova L.B., Kostrov V.A., Dorovskoy I.A. et al. A role of cardiopulmonary exercise testing for evaluation of physical capacity and respiratory function in healthy subjects. Vestnik sovremennoy klinicheskoy meditsiny. 2015; 8 (1): 35−42 (in Russian).
12. Kerbikov O.B., Aver’yanov A.V., Borskaya E.N. et al. Cardiopulmonary exercise testing in clinical practice. Klinicheskaya praktika. 2012; (2): 58−70 (in Russian).
13. Yartsev S.S. Basic Lung Functional Testing. Ergospirometry: A practical handbook. Moscow: RUDN; 2015 (in Russian).
14. ATS/ACCP statement on cardiopulmonary exercise testing. Am. J. Respir. Crit. Care Med. 2003; 167 (2): 211. DOI: 10.1164/rccm.167.2.211.
15. Ivanov S.V., Izachik Yu.A., Ivanov S.S. Cardiopulmonary exercise testing for evaluation of cardiovascular system. Funktsional’naya diagnostika. 2008; (1): 3−10 (in Russian).
16. Tavrovskaya T.V. Bicycle Ergometry. Saint-Petersburg: INKART; 2007 (in Russian).
17. Kropotov S.P., Kabanov M.V., Mordovin I.S. et al. Protocols of exercise testing using ergospirometry. Biotekhnosfera. 2014; 3132 (1-2): 12−17 (in Russian).
18. Rassouli F., Thurnheer R. Spiroergometrie – indikation, durchführung und interpretation. Swiss Medical Forum. 2015; 15 (14-15): 315–321. DOI: 10.4414/smf.2015.02227.
19. Baba R. The oxygen uptake efficiency slope and its value in the assessment of cardiorespiratory functional reserve. Congest Heart Fail. 2000; 6 (5): 256−258. DOI: 10.1111/j.1527-5299.2000.80164.x.
20. Westhoff M., Rühle K.H., Greiwing A. et al. Ventilatorische und metabolische (Laktat-) Schwellen. Dtsch. Med. Wochenschrift. 2013; 138 (6): 275−280. DOI: 10.1055/s-0032-1332843.
21. Lopes A.J., Menezes S.L., Dias C.M. et al. Comparison between cardiopulmonary exercise testing parameters and computed tomography findings in patients with thoracic sarcoidosis. Lung. 2011; 189 (5): 425−431. DOI: 10.1007/s00408-011-9316-1.
22. Wallaert B., Talleu C., Wemeau-Stervinou L. et al. Reduction of maximal oxygen uptake in sarcoidosis: relationship with disease severity. Respiration. 2011; 82 (6): 501−508. DOI: 10.1159/000330050.
23. Miller A., Brown L.K., Sloane M.F. et al. Cardiorespiratory responses to incremental exercise in sarcoidosis patients with normal spirometry. Chest. 1995; 107 (2): 323−329. DOI: 10.1378/chest.107.2.323.
24. Alshimemeri A.A., Itani M., Al-Jahdali H. Respiratory patterns throughout incremental exercise in individuals with sarcoidosis. Inn. J. Med. Health Sci. 2013; 3 (4): 149−152.
25. Lopes A.J., Menezes S.L.S., Dias C.M. et al. Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis. Braz. J. Med. Biol. Res. 2012; 45 (3): 256−263. DOI: 10.1590/S0100-879X2012007500018.
26. Błaut-Jurkowska J., Knap K., Kaźnica-Wiatr M. et al. [Exercise capacity in patients with pulmonary sarcoidosis]. Pol. Merkur. Lekarski. 2017; 43 (254): 61−65 (in Polish).
27. Savushkina O.I., Chernyak A.V. Detection of bronchial hyperreactivity (bronchospasm) using physical exercise test. Prakticheskaya pul’monologiya. 2016; (1): 50−54 (in Russian).
28. Ammenwerth W., Henrik W., Klemens M.A. et al. Reduced oxygen uptake efficiency slope in patients with cardiac sarcoidosis. PloS One. 2014; 9 (7): e102333. DOI: 10.1371/journal.pone.0102333.
29. Strookappe B., Swigris J., De Vries J. et al. Benefits of physical training in sarcoidosis. Lung. 2015; 193 (5): 701−708. DOI: 10.1007/s00408-015-9784-9.
Review
For citations:
Postnikova L.B., Gudim A.L., Kostrov V.A., Dorovskoy I.A., Soodayeva S.K., Popova N.A. Diagnostic role of cardiopulmonary exercise testing in patients with sarcoidosis. PULMONOLOGIYA. 2018;28(6):736-745. (In Russ.) https://doi.org/10.18093/0869-0189-2018-28-6-736-745
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