Tier 1 Longitudinal Case
Aggressive Prevention Restores Ideal Physiology
Ten CPET studies across 18 years tracked persistent cardiac dysfunction despite high functional capacity
Serial CPET Timeline
2019
Subclinical
Baseline for active period
Peak VO₂
103% predicted
IT Status
IT at HR 110 bpm
Stress ECG
No ST changes or ventricular ectopy
High Peak VO₂, but persistent subclinical cardiac dysfunction
2021
Subclinical
Exercise intensity shift
Peak VO₂
113% predicted
IT Status
IT at HR 112 bpm
Stress ECG
Normal stress ECG
Peak VO₂ rose with higher watts and O₂-pulse after more strenuous outdoor running
2023
Ideal
Endothelial support intensified
Peak VO₂
128% predicted
IT Status
No IT
Stress ECG
No ischemic signal reported
Highest Peak VO₂ in 18 years with normalized mechanical response
Interventions Between Tests
- Regular exercise evolved from gym training to more strenuous outdoor running
- Ramipril was added and titrated for persistent endothelial dysfunction pattern
- Beetroot powder was added as a nitric oxide and polyphenol support strategy
Clinical Interpretation
- The same patient became the control, making the physiologic change interpretable
- Peak VO₂ and O₂-pulse improvement supported better stroke-volume performance
- IT resolution showed transition from Stage 2 to Stage 1 physiology consistent with optimal left ventricular function
Peer-Reviewed Source
Chaudhry S, Kumar N, Arena R, Verma S. The evolving role of cardiopulmonary exercise testing in ischemic heart disease - state of the art review. Curr Opin Cardiol. 2023 Nov 1;38(6):552-572. doi:10.1097/HCO.0000000000001086
View journal article