Riassunto
The measurement of cardio-circulatory and gas-exchange parameters during phy sical exercise - the so-called ergo spirometry or cardiopulmonary exercise testing (CPX) - as a basis of pathophysiological and clinical research has a long tradition in Cologne. Knipping and his coworkers, especially Hollmann, performed basic re search work in healthy subjects. In the area of sports medicine, bicycle or treadmill exercise testing with parallel serial lactate determinations has gained increasing im portance for the assessment of cardiac functional capacity. Also, in other medical disciplines, ergospirometry lost its importance. K. Wasserman in Los Angeles is to be credited for having further improved the method to its present standard, a computerized, on-line measuring and practicable cardiopulmonary exercise testing procedure. The prerequisites were technical innovations, such as continuously measuring gas analyzers and personal computers. Thereby, the knowledge about physiology, pathophysiology, and clinical circumstances of cardiocirculatory and re spiratory regulation during exercise were significantly extended. The working groups of W. Hollmann, Cologne, and K. Wasserman, Los Angeles, determined normal values for the gas-exchange parameters and derived values for healthy normals in large populations. Wasserman and coworkers were able to introduce a differential diagnostic concept for patients suffering from various cardiovascular and cardio pulmonary diseases. Many cardiologists, working, for example in myocardial failure or with rate-adaptive pacemakers, belong to those who recommended the modem, computerized ergo spirometry. Furthermore, this method is controversely discussed· by colleagues working in sports medicine and pulmonary function.
Contenuti
1. Historical and Methodological Aspects.- On the History of Spiroergometry.- Dynamic coupling of External to Cellular Respiration During Exercise.- Determination of VO2 Kinetics by Means of Spectral Analysis: A New Method for Evaluation of Endurance Capacity.- The Importance of Lactate Measurement for the Determination of the Anaerobic Threshold.- The Significance of Spiroergometry from the Viewpoint of Sports Cardiology.- Thoracic Electrical Bioimpedance ― Alternative or Complement in Cardiopulmonary Exercise Testing?.- 2. Clinical Value in Coronary Heart Disease and Myocardial Failure.- Role of Spiroergometry in Clinical Excercise Testing.- Evaluation of the Cardiopulmonary Exercise Tolerance in Patients with Coronary Artery Disease (CAD) and Chronic Heart Failure (CHF).- Respiratory Gas Analysis in Patients with Chronic Heart Failure.- Influence of Phosphodiesterase Inhibitors on Aerobic Capacity in Chronic Heart Failure.- Effect of a Single Oral Dose of the PDE Inhibitor Milrinone on Exercise Tolerance of Chronic Heart Failure Patients ― CPX in Advanced Heart Failure.- Spiroergometry in Post Myocardial Infarction Patients with Compromised Left Ventricular Function.- 3. Clinical Value in Pacemaker Therapy.- Evaluation of Algorithms for Rate Adaptive Pacing by Gas Exchange Measurements.- Influence of Rate Responsive Pacing on Aerobic Capacity in Patients with Chronotropic Incompetence.- Cardiopulmonary Exercise Testing in Rate-Modulated Cardiac Pacing Based on Minute Ventilation and QT-Interval.- Evaluation of Temperature- and Activity-Controlled Rate-Adaptive Cardiac Pacemakers by Spiroergometry.- 4. Clinical Value in Pulmonary Diseases.- Effects of Inhaled Salbutamol and Oxitropium Bromide on Cardiopulmonary Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease and Coronary Artery Disease.- Cardiopulmonary Exercise Testing in the Diagnosis of HIV-Infected Patients.- Respiratory Parameters after Systemic Corticotropin-Releasing Hormone Administration.
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