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Advanced Cardiopulmonary Exercise Testing (ACPET) Program

Advanced cardiopulmonary exercise testing (ACPET) can help determine the primary cause of your undiagnosed chronic dyspnea on exertion – the recurring shortness of breath you experience when you exercise or engage in routine activities. If basic physical tasks, such as using stairs or walking the dog, make you feel exhausted and significantly affect your quality of life, your doctor may have referred you for an ACPET. 

This testing is for patients with underlying cardiopulmonary conditions, including:

  • Pulmonary hypertension
  • Pulmonary embolism
  • Diastolic dysfunction
  • Autoimmune disease (such as scleroderma and lupus)
  • Parenchymal lung diseases
    • COPD
    • Interstitial lung disease
    • Cystic fibrosis

Pulmonary function tests, including spirometry, lung volumes, and diffusion capacity, are the standard for diagnosing lung diseases. Evaluating exercise limitation in patients with multiple health conditions, however, is more challenging since the tests are performed at rest. ACPET effectively addresses that issue by challenging patients to exercise for eight to 12 minutes to monitor lung and heart capacity, as well as the circulatory system. After the ACPET, your pulmonologist will be able to determine the primary cause of your exercise fatigue and develop a comprehensive treatment plan that may include:

  • Medications 
  • Surgical or cardiac/pulmonary rehabilitation therapies
  • Participation in investigational research or clinical treatment trials 

What Can I Expect? 

ACPET is a minimally invasive outpatient procedure performed at the cardiac catheterization lab at UPMC Presbyterian. Patients return home the same day as the procedure and typically resume normal activity within 24 hours. 

The care team will place two catheters, one in the neck to measure heart and lung pressures and take blood samples, and one in the wrist to measure blood pressure and take blood samples. A mouth piece is used to evaluate gas levels breathed in and out. An EKG is performed, and the patient exercises on a stationary bicycle. 

Frequently Asked Questions

The exercise portion takes only eight to 12 minutes; however, you should expect to spend up to five hours at the hospital. 

Your time at the hospital will be spent as follows:

  • Up to one hour: wait time in the cath lab holding area, prior to the ACPET
  • Up to three hours: time to complete testing procedures, including line(s) placement, setting up the cath lab room, exercise, and recovery time from exercise
  • One hour: observation in the cath lab holding area prior to discharge home after the study

We try to move you around as little as possible. You will stay in one room for the study. 

All movement will be performed within six feet of the cath table. 

You will be moved from the cath table to a comfortable chair, where we measure pressures while you are seated. We then move you to the upright bicycle, which you will ride for up to 12 minutes. The distance from the cath lab table to the chair and bicycle is very short (under six feet). 

The care team will assist you with these position changes and will keep you untangled. 

The day of your ACPET, the pulmonologist will explain the procedure in detail and obtain your consent to perform the testing.

Try your best to exercise for as long as you can. A longer duration of exercise produces more accurate results. 

The amount of exercise you perform will vary based on your age, height and gender. The goal is eight to 12 minutes of exercise. We adjust the resistance so that it is not very hard to pedal until the last 10 percent of the study. 

Once the study is over, we will make it easy to pedal, and you will cool down for two to three minutes. 

The ACPET study gathers a lot of information and takes hours to put together. 

After the study is performed, the ACPET team will have a general idea regarding the results and can give you some preliminary information. 

Your referring physician will receive your ACPET results, and provide you with a full report in about one week. 

The ACPET can help us identify numerous conditions causing your shortness of breath or tiredness with exercise (exercise intolerance).

Some patients suffer from only one health issue, while others with more complex conditions may have numerous issues. 

We may find one or more of the following as the cause(s) of your dyspnea. 

Lung problems due to:

  • Lung scarring 
  • COPD/emphysema 
  • Asthma
  • Cystic Fibrosis

Blood vessel problems due to:

  • Pulmonary arterial hypertension 
  • Exercise pulmonary hypertension
  • Chronic blood clots or pulmonary embolism 
  • Low blood pressure with exercise (pre-load insufficiency)

Heart problems due to:

  • Diastolic dysfunction (HFpEF, pulmonary venous hypertension, stiff left heart)
  • Systolic dysfunction (weak left heart)
  • Aortic or mitral heart valve problems
  • Coronary artery disease/heart vessel blockage

Muscle problems of the legs (skeletal muscle)

Deconditioning (the need for more exercise, which many people need)

Prior to the arrival at the cath lab or on the day of the ACPET, you may be asked to participate in research data collection by a physician or one of our study coordinators. 

These ACPET studies generate useful and unique information, and we would like to use this information for research purposes to help other patients like you.

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