Usefulness of the cardiopulmonary exercise tests in the diagnosis of tachycardiomyopathy

Morón Ortiz, María; Perera Louvier, Rafael; Almadana Pacheco, Virginia

doi:10.1016/j.medcle.2021.11.003

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In these cases, cardiopulmonary exercise testing (CPET) is a very useful diagnostic option.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a>In this paper we describe the case of a 20-year-old man whose only personal medical history was interventricular communication (IVC) that was studied, corrected, and not found to have hemodynamic repercussion, as well as an episode of syncope categorized as vasovagal. He visited the Emergency Department due to experiencing a selflimited episode of chest pain radiating toward his left arm and associated with exertional dyspnea (modified Medical Research Council [mMRC] grade 2) for the past few months. Because sinus tachycardia was detected in the Emergency Department, he was referred for a cardiology consultation. During his assessment at the Cardiology Department, an echocardiogram revealed normal findings, without data of IVC, owing to which his dyspnea was attributed to anxiety and he was referred to the Pulmonology Department for additional testing. At said department, he underwent a spirometry that measured a forced vital capacity (FVC) of 5390 cc (95.7%), a forced expiratory volume in one second (FEV1) of 4420 cc (82%), a FEV1/FVC ratio of 0.78, a diffusing capacity of the lung for carbon dioxide (DLCO) of 93%, a corrected DLCO of 101%, and the following pulmonary volumes: total lung capacity (TLC) of 97%, residual volume (RV) of 127%, inspiratory capacity of 86%, expiratory reserve volume of 82%, and RV/TLC ratio of 30%. He also completed a sixminute walk test, during which he covered 666m without desaturations and with both initial (128 beats per minute [bpm]) and final tachycardia (208 bpm). Given these results, CPET was requested. This testing was performed with a cycle ergometer applying an incremental protocol of 15W/min for a total duration of 16minutes. Based on the results of this testing, his dyspnea was scored at 5/10 in the BORG scale, without electrocardiographic alterations. He reached a total of 104W (41%) and a respiratory exchange ratio (RER) of 1.21, reflective of maximum effort. As for his metabolic response, he reached a maximum oxygen consumption (VO2) of 1388ml/min (41%), with a VO2/kg of 23.1. His anaerobic threshold was set at 22% of the maximum theoretical VO2 according to the ventilatory equivalence method. Regarding his cardiovascular response, he reached a heart rate (HR) of 193 bpm (97% of his theoretical rate), fully depleting his cardiac reserve, starting from a high baseline HR (119 bpm). His oxygen pulse was 7.2ml (46%). As for his ventilatory response, he reached 37% of his maximum voluntary ventilation, without episodes of desaturation. Considering these findings, we were able to conclude that the patient had a severe exercise limitation of cardiological nature, which could be caused by either inappropriate sinus tachycardia or a tachycardiomyopathy. Given the undetermined etiology, a second echocardiogram was requested, observing moderate left ventricular systolic dysfunction on this occasion, owing to which he was referred back to the Cardiology Department. A Holter electrocardiogram (ECG) study was performed, detecting tachycardiomyopathy secondary to atrial tachycardia. An electrophysiological study was also carried out, with no foci of inducible arrhythmias or accessory pathways being detected. The patient was consequently treated with bisoprolol, exhibiting a good subsequent clinical and echocardiographic evolution.Tachycardiomyopathy is an underdiagnosed and reversible cause of left ventricular dysfunction induced by persistent arrhythmia. Establishing a diagnosis of tachycardiomyopathy is a difficult task and requires a high degree of suspicion. An arrhythmic etiology should always be considered as a contributing factor to cardiac dysfunction, especially in the absence of ventricular structural abnormalities, as in the case of our patient, who had a previous normal echocardiogram.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Although both increased ventilatory demand and altered ventilatory mechanisms are present in most cardiopulmonary diseases, a discordance between the patient's symptoms and the results of their initial tests is occasionally found.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In this particular case, the conduct of more complex tests such as CPET, which can be useful to aid in differentiating dyspnea of respiratory origin from that of cardiac origin, or to evaluate multifactorial dyspnea, is of particular interest.<a class="elsevierStyleCrossRefs" href="#bib0010">2–4</a>Therefore, we can conclude that CPET should be the first choice in the study of dyspnea of undetermined etiology based on the normal results obtained in initial tests.<a class="elsevierStyleCrossRefs" href="#bib0010">2–4</a>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "Please cite this article as: Morón Ortiz M, Perera Louvier R, Almadana Pacheco V. Utilidad de la prueba de esfuerzo cardiopulmonar en el diagnóstico de la taquicardiomiopatía. Med Clin (Barc). 2021;157:551–552." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An official American Thoracic Society statement: Update on the mechanisms, assessment, and management of dyspnea" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Parshall" 1 => "R.M. Schwartzstein" 2 => "L. Adams" 3 => "R.B. Banzett" 4 => "H.L. Manning" 5 => "J. Bourbeau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201111-2042ST" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2012" "volumen" => "185" "paginaInicial" => "435" "paginaFinal" => "452" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22336677" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendation on the use of exercise testing in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Palange" 1 => "S.A. Ward" 2 => "K.-H. Carlsen" 3 => "R. Casaburi" 4 => "C.G. Gallagher" 5 => "R. Gosselink" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00046906" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2007" "volumen" => "29" "paginaInicial" => "185" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17197484" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Norvativa SEPAR. Prueba de Ejercicio Cardiopulmonar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Roca Torrent" 1 => "F. Burgos Rincón" 2 => "P. Casan Clará" 3 => "F. Ortega Ruiz" 4 => "L. Puente-Maestu" 5 => "B. Togores Solivellas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "247" "paginaFinal" => "268" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Statement on cardiopulmonary exercise testing" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Thoracic Society, American College of Chest Physicians" "etal" => false "autores" => array:6 [ 0 => "I.M. Weisman" 1 => "D. Marciniuk" 2 => "F.J. Martinez" 3 => "F. Sciurba" 4 => "D. Sue" 5 => "J. Myers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.167.2.211" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2003" "volumen" => "167" "paginaInicial" => "211" "paginaFinal" => "277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12524257" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology, diagnosis and treatment of tachycardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Martin" 1 => "P.D. Lambiase" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2016-310391" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2017" "volumen" => "103" "paginaInicial" => "1543" "paginaFinal" => "1552" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28855272" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000011/v1_202112030828/S2387020621006409/v1_202112030828/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000011/v1_202112030828/S2387020621006409/v1_202112030828/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006409?idApp=UINPBA00004N"]

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Vol. 157. Issue 11.