Invasive cardiopulmonary exercise testing in the evaluation of unexplained dyspnea: Insights from a multidisciplinary dyspnea center

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dc.citation.issue11]
dc.citation.volume24]
dc.contributor.authorHuang, Wei
dc.contributor.authorResch, Stephen
dc.contributor.authorOliveira, Rudolf K. F.
dc.contributor.authorCockrill, Barbara A.
dc.contributor.authorSystrom, David M. [UNIFESP]
dc.contributor.authorWaxman, Aaron B.
dc.coverageLondon
dc.date.accessioned2020-06-26T16:30:31Z
dc.date.available2020-06-26T16:30:31Z
dc.date.issued2017
dc.description.abstractBackground: Unexplained dyspnea is a common diagnosis that often results in repeated diagnostic testing and even delayed treatments while a determination of the cause is being investigated. Through a retrospective study, we evaluated the diagnostic efficacy of a multidisciplinary dyspnea evaluation center (MDEC) using invasive cardiopulmonary exercise test to diagnose potential causes of unexplained dyspnea. Methods: We reviewed the medical records of all patients referred with unexplained dyspnea to the MDEC between March 2011 and October 2014. We assessed the diagnostic efficacy before and after presentation to the MDEC. Results: During the study period a total of 864 patients were referred to the MDEC and, of those, 530 patients underwent further investigation with invasive cardiopulmonary exercise test and constituted the study sample. The median age was 57 (44-68) years, 67.2% were women, and median body mass index was 26.22 (22.78-31.01). A diagnosis was made in 530 patients including: exercise pulmonary arterial hypertension of 88 (16.6%), heart failure with preserved ejection fraction of 94 (17.7%), dysautonomia 112 (21.1%), oxidative myopathy of 130 (24.5%), primary hyperventilation of 43 (8.1%), and other 58 (10.9%). The time from initial presentation to referral was significantly longer than time to diagnosis after referral for non-standardized conventional methods versus diagnosis through MDEC using invasive cardiopulmonary exercise test (511 days (292-1095 days) vs. 27 days (13-53 days), p<0.0001). In a subgroup analysis, we reviewed that patients referred from cardiovascular clinics were more likely to have a greater number of diagnostic tests performed and, conversely, patients referred from pulmonary clinics were more likely to have a greater number of treatments prescribed before referral to MDEC. Conclusions: As a result of this retrospective study, we have evaluated that a multidisciplinary approach that includes invasive cardiopulmonary exercise test dramatically reduces the time to diagnosis compared with traditional treatment and testing methods.en
dc.description.affiliationChongqing Med Univ, Affiliated Hosp 1, Dept Cardiol, Chongqing, Peoples R China
dc.description.affiliationBrigham & Womens Hosp, Pulm & Crit Care Med, Pulm Vasc Dis Program, 75 Francis St,PBB CA-3, Boston, MA 02115 USA
dc.description.affiliationHarvard TH Chan Sch Publ Hlth, Dept Hlth Policy & Management, Ctr Hlth & Decis Sci, Boston, MA USA
dc.description.affiliationFed Univ Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Sao Paulo, Brazil
dc.description.affiliationUnifespFed Univ Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipNational Natural Science Foundation of China
dc.description.sponsorshipNatural Science Foundation of Chongqing
dc.description.sponsorshipSao Paulo Research Foundation (FAPESP)
dc.description.sponsorshipBrazilian National Council for Scientific and Technological Development (CNPq)
dc.description.sponsorshipNIH/NHLBI
dc.description.sponsorshipIDNational Natural Science Foundation of China: 81170188
dc.description.sponsorshipIDNational Natural Science Foundation of China: 30971212
dc.description.sponsorshipIDNatural Science Foundation of Chongqing: CSCT2009BB5069
dc.description.sponsorshipIDFAPESP: 2014/12212-5
dc.description.sponsorshipIDCNPq: 232643/2014-8
dc.description.sponsorshipIDNIH/NHLBI: HL06023412A1
dc.description.sponsorshipIDNIH/NHLBI: U01 HL125215
dc.format.extent1190-1199
dc.identifierhttp://dx.doi.org/10.1177/2047487317709605]
dc.identifier.citationEuropean Journal Of Preventive Cardiology. London, v. 24, n. 11, p. 1190-1199, 2017.
dc.identifier.doi10.1177/2047487317709605
dc.identifier.issn2047-4873
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/53595
dc.identifier.wosWOS:000404724300010
dc.language.isoeng
dc.publisherSage Publications Ltd
dc.relation.ispartofEuropean Journal Of Preventive Cardiology
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectDyspneaen
dc.subjectexertional intoleranceen
dc.subjectinvasive CPETen
dc.subjectevaluationen
dc.subjectexercise testingen
dc.titleInvasive cardiopulmonary exercise testing in the evaluation of unexplained dyspnea: Insights from a multidisciplinary dyspnea centeren
dc.typeinfo:eu-repo/semantics/article
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