This book is the latest edition of the classic text on cardiopulmonary exercise testing written by Dr Wasserman and colleagues at the University of California, Los Angeles, USA. It is not for the ‘faint of heart’ because it serves as the definitive text for this topic and embraces the spectrum from the physiology of exercise to clinical applications.
“It is likely that no test in medicine can be used to diagnose the broad spectrum of diseases, while also quantifying severity of organ dysfunction of improvement in the pathophysiology of exercise intolerance, better than cardiopulmonary exercise testing.” (Preface from Principles of Exercise Testing and Interpretation, 4th edn.)
Although one might quibble as to which test would hold this distinction, there is little doubt about the importance and usefulness of cardiopulmonary testing. Although traditional cardiology stress testing facilities primarily focus on cardiac response, the popularity of the combined cardiac and respiratory testing is increasing. It makes intuitive sense that the appropriate investigation of exercise intolerance, dyspnea or fatigue needs to incorporate the spectrum of gas exchange from the cell to the environment. The cause(s) for such diagnostic problems may be found in the lungs, heart, pulmonary circulation or the muscles themselves.
Other uses for cardiopulmonary testing have included:
the evaluation of heart failure patients for transplantation;
an in-depth evaluation of heart failure and congenital heart failure patients to assess cardiac and pulmonary status;
an objective evaluation of work capacity. Traditional stress tests using a treadmill or bicycle give an estimated workload (usually reported in metabolic equivalents) for peak capacity. Such estimates may have significant errors, especially at peak exercise; and
an objective measure of performance for research studies. Indeed, most funded research mandates the accurate measurement of oxygen uptake and other cardiopulmonary parameters.
The text is divided into 10 sections, which include an overview of exercise testing and interpretation, physiology of exercise, changes in blood gases and pH during exercise, measurements during integrative cardiopulmonary exercise testing, pathophysiology of disorders limiting exercise, clinical exercise testing, normal values, principles of interpretation, Wasserman’s approach to analysis using logic algorithms, clinical applications of cardiopulmonary exercise testing, 85 case studies and four appendixes.
The organization is logical and proves the appropriate sequence. The flowchart interpretation and nine-plot montage of exercise data have been developed by Dr Wasserman over the past 20 years. This format has been adopted by major cardiopulmonary metabolic cart manufactures.
The presentation and format is clean, and the diagrams are well presented. The references are complete and include some of the classics, with a sufficient number of more recent articles.
Any exercise laboratory that wishes to embrace this testing modality should have Principles of Exercise Testing and Interpretation as one of the core references. I would recommend that any physicians embarking on this field take the course at the University of California, Los Angeles, taught by Dr Wassernam. The text is used as the backbone for the course; other introductory texts on cardiopulmonary testing should be used to complement this text.