A 41 yo woman is referred to you for cardiopulmonary exercise testing (CPET). She has a history of systolic CHF due to non-ischemic cardiomyopathy (EF 15%). She is currently on maximal medical therapy. Pulmonary function testing reveals no airflow obstruction and no restrictive ventilatory defect. FEV1 is 99% predicted, FVC is 97% predicted and DLCO is 81% predicted. CPET is performed. Maximal effort is achieved and the patient stops due to leg fatigue. Selected data from the test are below.
What is the next best step in management for this patient?
- Continued medical management only
- Referral for cardiac transplantation
- Referral for pulmonary rehabilitation
See the following references:
1) ZACH MORRIS
2) Weisman IM and Zeballos RJ. An integrative approach to the interpretation of cardiopulmonary exercise testing. Prog Respir Res. 2002. vol 32, 300-322.
3) Hunt SA, et al. 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009; 119(14): e391.