Tier 1 Longitudinal Case
High Coronary Calcium With Preserved Longitudinal Function
Very high coronary calcium was tracked alongside serial CPET to distinguish anatomy from functional trajectory
Serial CPET Timeline
2018
Subclinical
Baseline surveillance
Peak VO₂
133% predicted
IT Status
IT at HR 104 bpm
Stress ECG
No ST changes or PVCs
Excellent fitness with persistent subclinical dysfunction
2022
Subclinical
Functional decline
Peak VO₂
115% predicted
IT Status
IT at HR 118 bpm
Stress ECG
Normal stress ECG
O₂-pulse trajectory worsened and sank in late exercise
2023
Subclinical
Therapy intensification
Peak VO₂
144% predicted
IT Status
IT at HR 110 bpm
Stress ECG
Normal stress ECG
O₂-pulse no longer sank in late exercise, consistent with regression of disease physiology
Interventions Between Tests
- CTA showed diffuse CAD with CAC greater than 1000 after unremarkable stress echocardiogram
- Exercise regimen was intensified
- Vascepa and GLP-1 therapy were added to support triglyceride and glycemic control
Clinical Interpretation
- Anatomic plaque burden and physiologic trajectory can diverge
- Aggressive prevention helped preserve high Peak VO₂ despite high CAC
- Serial CPET provided the functional readout needed for ongoing primary prevention
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