Paramus-based Valley Health System is introducing a specialized and highly advanced diagnostic service, the Invasive Cardiopulmonary Exercise Testing (iCPET), for patients struggling with shortness of breath that remains unexplained by standard medical evaluations.
Offered through a collaboration between The Valley Hospital’s pulmonary arterial hypertension and interventional cardiology teams, the iCPET test provides a “one-stop shop” solution to identify subtle cardiovascular and pulmonary issues that manifest only under physical stress.
Bridging the diagnostic gap
Many patients experience exercise-induced shortness of breath even after undergoing comprehensive standard evaluations, including echocardiograms, CT scans, stress tests, and pulmonary function tests, all of which often yield no definitive cause.
“This iCPET can give a bigger picture as to whether it is the heart or lungs that could be contributing more to symptoms,” Dr. Ashish Rai, director of the Pulmonary Arterial Hypertension Program at The Valley Hospital, said.
The key difference between iCPET and traditional methods is its ability to simultaneously evaluate the function of both the heart and the lungs during exercise. Most standard tests are performed while the patient is at rest, potentially missing dynamic problems.
How the invasive test works
The specialized outpatient test, performed at The Valley Hospital, combines two critical procedures:
- Right Heart Catheterization: A thin catheter is inserted, typically through the neck, to precisely measure the pressures within the heart’s chambers.
- Cardiopulmonary Exercise Testing: After a resting baseline is established, the patient exercises on a stationary bicycle for up to 10 minutes at maximal effort.
During this exercise phase, physicians closely monitor multiple variables, including:
- Respiratory function and oxygenation
- Pressures in the heart
- Blood pressure
The test typically takes between 45 minutes to an hour to complete and results in a comprehensive evaluation of a patient’s overall cardiopulmonary function.
Diagnosing missed conditions
The primary goal of iCPET is to diagnose challenging conditions that are frequently missed by conventional testing. These may include:
- Exercise-induced pulmonary hypertension
- Exercise-induced heart failure with preserved ejection fraction (a condition where the left ventricle stiffens and cannot fill properly)
- Oxygen extraction issues (problems with tissues consuming oxygen)
“iCPET is a way to help people in a ‘one-stop shop’ type of way by combining two tests and seeing how the heart and lungs work together,” Dr. Hussein Rahim, associate director of the Structural Heart Program at The Valley Hospital said. “With the results generated from these tests, our team can determine if further interventions will be needed.”
Patients who have persistent, unexplained exercise-induced shortness of breath are encouraged to speak with their cardiologist or pulmonologist to determine if iCPET is the right diagnostic step.
