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Original Research: PHYSIOLOGIC TESTING |

Do Maximum Flow-Volume Loops Collected During Maximum Exercise Test Alter the Main Cardiopulmonary Parameters?

Maurizio Bussotti, MD; PierGiuseppe Agostoni, MD, PhD; Alberto Durigato, MD; Carlo Santoriello, MD; Stefania Farina, MD; Vito Brusasco, MD; Riccardo Pellegrino, MD
Author and Funding Information

*From the Istituto di Cardiologia dell'Università degli Studi di Milano (Drs. Bussotti, Agostoni, and Farina), Centro Cardiologico, Istituto di Ricovero e Cura a Carattere Scientifico, Centro di Studio per le Ricerche Cardiovascolari del Centro Di Studio per le Ricerche, Milan, Italy; SC Pneumologia (Dr. Durigato), Ospedale Cà Foncello, Treviso, Italy; OUC Fisiopatologia Respiratoria (Dr. Santoriello), Ospedale Cava De'Tirreni (SA), Tirreni, Italy; Cattedra di Fisiopatologia Respiratoria (Dr. Brusasco), DISM, Università di Genova, Genoa, Italy; and Centro di Fisiopatologia Respiratoria (Dr. Pellegrino), Azienda Sanitaria Ospedaliera S Croce e Carle, Cuneo, Italy.

Correspondence to: Maurizio Bussotti, MD, Centro Cardiologico Monzino, Department of Cardiology, Via Parea 4, Milan 20138, Italy; e-mail: maurizio.bussotti@ccfm.it


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):425-433. doi:10.1378/chest.08-1477
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Background:  Traditionally, ventilatory limitation to exercise is assessed by measuring the breathing reserve (BRR) [ie, the difference between minute ventilation at peak exercise and maximum voluntary ventilation measured at rest]. Recent studies have however, documented important abnormalities in ventilatory adaptation with a remarkable potential to limit exercise even in the presence of a normal BRR. Among these abnormalities is lung hyperinflation and expiratory flow limitation. This was documented by comparing tidal to maximum flow-volume loops (FVLs) collected throughout the test. In the present study, we wondered whether the advantages of using such a technique within the classic cardiopulmonary exercise test (CPET) might be obscured by the maneuvers interfering with the main functional parameters of the test, and eventually with interpretation of the CPET.

Methods:  We studied 18 healthy subjects, 19 patients affected by COPD, and 19 patients with chronic heart failure during a maximum exercise test on three different study days in a random order. On one occasion, the CPET was conducted with no FVLs (control test [CTRL]), whereas on the other occasions FVLs were incorporated every 1 min during exercise (FVL1-min) or every 2 min during exercise (FVL2-min).

Results:  None of the classic cardiovascular parameters recorded at ventilatory anaerobic threshold or at peak exercise differed between the study days (by analysis of variance). Furthermore, the coefficients of variation of the main parameters between FVL1-min and FVL2-min days vs CTRL day were well within the natural variability thresholds reported in the literature.

Conclusions:  The FVLs appear to not interfere with the main functional parameters used for the interpretation of CPET.

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