Tier 1 Longitudinal Case
Master Athlete Progression Despite High Fitness
Progressive dyspnea at high intensity developed despite elite Peak VO₂ and a normal stress echocardiogram
Serial CPET Timeline
2016
Subclinical
Symptom evaluation
Peak VO₂
155% predicted
IT Status
IT at HR 119 bpm
Stress ECG
Borderline ST changes with PVCs
Elite CRF coexisted with a subclinical dysfunction pattern
June 2022
Clinical
Worsening dyspnea and chest tightness
Peak VO₂
127% predicted
IT Status
IT at HR 102 bpm
Stress ECG
ST depression with PVCs
Stress echocardiogram was unremarkable despite clear CPET progression
Sept 2022
Clinical
Post-PCI and home rehab
Peak VO₂
140% predicted
IT Status
IT at HR 98 bpm
Stress ECG
ST depression with persistent PVCs
Peak VO₂ improved primarily through HR response, not stroke-volume recovery
Interventions Between Tests
- Ezetimibe was added to low-intensity statin therapy
- Angiography revealed severe RCA and distal LAD disease requiring two stents
- Lipid therapy was intensified and home-based exercise rehab was started
Clinical Interpretation
- Normal stress echo did not exclude abnormal exercise physiology
- Persistent IT with ST depression after PCI is strongly consistent with residual microvascular ischemia
- Serial CPET identified the need for further disease-modifying therapy
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