Abstract Body (Do not enter title and authors here): Introduction: The clinical value of exercise hemodynamic measurements is increasingly recognized, but optimal methods of exercise hemodynamic data acquisition lack consensus. Pairing simultaneous invasive exercise hemodynamic measurements with maximum effort cardiopulmonary exercise testing (iCPET) places hemodynamic data in the context of overall exercise capacity and gas exchange patterns. We hypothesized that adding upright invasive hemodynamic measurements during repeat CPET would permit similar exercise performance.
Objective: To assess the reproducibility of CPET measurements between non-invasive CPETs (niCPETs) and iCPETs.
Methods: We investigated a single-center referral cohort of patients with exertional dyspnea who had niCPET and iCPET within a ≤1-year interval. We excluded patients who had major interval events or fitness-modulating interventions between tests, including cardiac rehabilitation, pulmonary vasodilators, and anemia treatment. Paired student's t-testing was conducted with p-values<0.05 deemed statistically significant.
Results: Among 111 patients who underwent niCPET and iCPET, 74 met inclusion criteria (mean age 57.9±17.0 years, 43 female [58%]). The mean time period between tests was 5.2±2.7 months. From niCPET to iCPET, 98% of patients achieved RER>1.0, consistent with maximal volitional effort. All CPET variables derived during exercise were similar between tests, indicating the ability of patients to achieve high reproducibility of maximum niCPET when invasive hemodynamics are added (Table). Systolic and diastolic blood pressure (BP) at rest and peak exercise were significantly higher from iCPETs (p<0.001), likely reflecting higher precision of arterial line assessments during maximum incremental exercise.
Conclusion: This study demonstrates the feasibility and reproducibility of maximum CPET measures with added invasive upright hemodynamic assessment. Achievement of consistent peak exercise capacity with integrated invasive hemodynamics holds promise for comprehensive mapping and ranking physiologic deficits that contribute to exercise intolerance through single integrated tests when phenotyping complex conditions such as heart failure with preserved ejection fraction.