Cardiopulmonary exercise testing (CPET) allows the objective measurement of patients’ exercise capacity. In contrast to traditional and static investigations for limited exercise tolerance, CPET can provide a global and dynamic evaluation of both cardiovascular and respiratory systems and their functional interactions. There is increasing literature to support the use of CPET in various clinical settings. Its role has been established for the evaluation of chronic heart failure especially for prognosis, measurement of response to treatment and assessment of suitability for heart transplantation. CPET has also been used for assessment of patient’s suitability for lung resection. There is currently a lot of interest in the use of CPET as a tool for the preoperative evaluation of patients for noncardiac surgery. Poor fitness levels as measured by CPET variables are shown to be associated with perioperative morbidity and mortality. It can therefore be very useful in risk stratification, preoperative optimisation, patient informed consent process for surgery and allocation of healthcare resources. In this article we review the basic physiological principles behind its use and the conduct of testing. We also summarise the latest evidence relevant to its current clinical applications, with emphasis on management of chronic heart failure, assessment of patient’s suitability for lung resection and preoperative stratification of surgical risk.
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