Tier 1 Longitudinal Case
A Missed Prevention Window Becomes Secondary Prevention
Baseline risk assessment was followed by acute coronary syndrome and PCI six years later
Serial CPET Timeline
2016
Ideal
Baseline risk assessment
Peak VO₂
105% predicted
IT Status
Borderline cardiac dysfunction pattern
Stress ECG
No reported ischemic ECG signal
Considered healthy because HR decelerated late and peak values were normal
2022
Clinical
Post-ACS, pre-rehab
Peak VO₂
84% predicted
IT Status
Dysfunction at HR 95 bpm
Stress ECG
Post-PCI testing on beta-blocker therapy
Watts, Peak VO₂, O₂-pulse and HR all fell compared with baseline
2023
Subclinical
First surveillance CPET
Peak VO₂
107% predicted
IT Status
Persistent dysfunction at HR 98 bpm
Stress ECG
Persistent post-PCI physiology signal
Peak VO₂ improved after rehab, but residual dysfunction remains
Interventions Between Tests
- PCI with two stents after acute coronary syndrome
- Statin, beta-blocker and anti-platelet therapy after discharge
- Cardiac rehab, increased physical activity, diet improvement and ACE inhibitor addition
Clinical Interpretation
- Large-vessel PCI did not fully normalize coronary physiology
- Persistent IT implied residual microvascular ischemia for clinician review
- Annual CPET could support secondary-prevention intensification
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