Cardiopulmonary Exercise Testing Limitation in Peripheral Arterial Disease.

BACKGROUND

Peripheral artery disease (PAD) is associated with a markedly increased risk of cardiovascular mortality and remains underrecognized and undertreated. New screening approaches are needed to prevent disability in patients with PAD.

METHODS

We performed a retrospective analysis of clinically stable cardiovascular patients who were referred for cardiopulmonary exercise testing (CPET) due to a variety of cardiovascular complaints. Angiograms were assessed for patients who prematurely terminated CPET. Estimated functional capacity in metabolic equivalents was also obtained from monitored bicycle exercise at the visit.

RESULTS

According to our analysis, 351 patients were unable to complete the CPET test due to some limiting factor. Of these patients, a total of 216 had available angiographic assessment conducted, of whom 42.6% were males, 57.4% were females, and the mean age was 67 years. A total of 135 patients with a similar gender distribution and a mean age of 53 years did not undergo angiography for various reasons including feasibility. Most patients who underwent assessment were found to have lesions. Across all patients, 284 arterial lesions were identified: 55 were iliac, 67 were femoral, and 162 were below the knee. PAD was diagnosed in 165 of these lesions. There was a significant difference observed in the VO2 max in patients with lesions depending on location of lesion. In all vessel groups, the existence of PAD was associated with a significantly reduced VO2 max during CPET testing.

CONCLUSIONS

The data obtained in this study provides a preliminary understanding of the underlying effects of PAD and provides a basis for further utilization of CPET termination as a potential screening signal for further PAD investigation in appropriate patients.