1Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada2University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France3Service de Pneumologie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France4Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy5Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; and6Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Département Respiration, Réanimation, Réhabilitation, Sommeil, Pôle PRAGUES, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Höpitaux de Paris, Paris, France
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Cardiopulmonary exercise testing allows the assessment of the integrative cardiopulmonary response to exercise and is a useful tool to assess the underlying pathophysiologic mechanisms leading to exercise intolerance. Patients with pulmonary hypertension often face a considerable delay in diagnosis due to the rarity of the disease and nonspecific symptoms of dyspnea, fatigue, and exercise limitation. Cardiopulmonary exercise testing may be suggestive of pulmonary hypertension in patients with evidence of both circulatory impairment and ventilatory inefficiency. Other factors, such as mechanical ventilatory constraints from dynamic hyperinflation and peripheral muscle dysfunction, contribute to the profound dyspnea during exercise experienced by many patients with pulmonary hypertension. In patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension, several exercise variables, such as low peak Symbolo2, high Vd/Vt, and high Symbole/Symbolco2, have proven to be useful in establishing the severity of functional impairment, predicting prognosis, and assessing the efficacy of interventions.