Barbara LeVarge, MD, a pulmonologist and associate professor at the University of North Carolina Department of Medicine, is using a new cardiopulmonary test, invasive CPET, at 黑料网 Hillsborough to better understand complex conditions.
“In my mind, Dr. LeVarge essentially saved my life,” Ed Boiar says. “I have real admiration for her work.”听
It鈥檚 the summer of 2017, Ed is enjoying life, golfing and spending time with his children, except for his increased difficulty breathing. After nagging from his golf buddies, Ed agrees to visit an urgent care. This was followed by a trip to the emergency room, a diagnosed heart attack, and continued difficulty breathing, even after a catheterization found no blockage in the heart.听
One of Ed鈥檚 golf buddies who noticed his frustration with continued breathing troubles was a 黑料网 Cardiologist. He performed scans to determine the blockage was in Ed鈥檚 lungs. Ed was referred to Barbara LeVarge, MD, a world-class pulmonologist.听
After completing various kinds of tests and scans, Dr. LeVarge’s diagnosis was serious: Ed had chronic blood clots in his lungs significantly limiting his life expectancy. Ed underwent an intense operation that required opening his chest to remove the clots, and a ten-day recovery in the hospital.听
Once recovered, Ed鈥檚 life returned to normal with the occasional check-in with Dr. LeVarge. After some recent appointments and a lung assessment, his bloodwork showed slightly elevated markers. Dr. LeVarge recommended a new diagnostic tool they had begun offering at 黑料网 Hillsborough: invasive, or 鈥渓evel 3鈥� Cardiopulmonary Exercise Testing (CPET).听
CPET Purpose and Process
Invasive CPET is especially valuable when traditional workups like chest X-rays, echocardiograms, and pulmonary function tests come back normal, allowing for more informed treatment decisions. Invasive CPET uses catheters to directly measure blood gases and cardiovascular pressures. Non-invasive CPET, on the other hand, uses external sensors to monitor breathing, heart rate, and gas exchange, offering an assessment without penetrating the body. While invasive CPET is more involved, it provides highly detailed and direct measurements that can be essential for diagnosing complex or unclear conditions. The approach chosen depends on clinical needs and the level of diagnostic detail required.听
鈥淭his is a standard cardiopulmonary exercise test done on a bike, but prior to the start of the exercise study, the patient has a pulmonary artery catheter placed as well as a radial artery catheter allowing for the continuous assessment of intracardiac and intrapulmonary pressures as well as collection of blood gases each minute.鈥� explains Dr. LeVarge.”It’s designed to diagnose somebody who has unexplained exertional shortness of breath or exertional limitation.”听
Pedaling Phase听
The test begins with catheter placement in the wrist and neck to measure pressures on both sides of the heart, collect blood gases, and calculate cardiac output throughout the exercise. This allows providers to precisely identify where things go wrong during exertion.听
鈥淵ou know, it’s a little weird just thinking that you have a catheter in your neck going into your heart and they’re going to wheel you over to the bicycle,鈥� said Ed.听听
It was a unique ride for Ed but one that was reassuring in the end.听听
CPET evaluates how the heart, lungs, and muscles work together during exercise. The test is conducted on a stationary bike where patients gradually increase their level of exertion over approximately 10 minutes while clinicians monitor critical physiological markers.听听
The test measures minute ventilation鈥攖he amount of gas they’re inhaling and exhaling, how efficiently they’re eliminating carbon dioxide, and VO2 peak (the maximum amount of oxygen a patient can consume during the study).听
This procedure, offered by only a handful of centers nationwide, is now performed at 黑料网 Hillsborough, thanks to the coordination of Dr. LeVarge, Respiratory Therapist Justinee Vanier, and James Ford III,MD, who is the Director of the Pulmonary Hypertension Program.听听
Turning Data Into Direction
听“A test that provides objective data to complement how patients are feeling is very powerful.”听 Dr. LeVarge explains. 鈥淔or Ed, he had been feeling pretty well overall, though his lab work offered concern about developing a recurrence of his pulmonary hypertension from chronic blood clots. Fortunately, his resting pulmonary pressures were normal and they remained within normal limits in response to exercise. This was an excellent result and no changes to his management plan were needed.鈥澨�
听Ed now takes just one medication and is grateful to avoid unnecessary prescriptions. For Ed, the CPET wasn’t just another test. It confirmed his recovery was on track and gave him confidence in his care plan moving forward.听
“Considering the severity of my prior procedures, this was literally nothing,” Ed reflects. “It’s obviously something, but in my world, it’s very easy, very simple. If I had to do it every year, I’d do it every year.”听
Dr. Levarge has seen the effect on outcomes invasive CPET allows, 鈥淚nvasive CPET is a very powerful tool and can provide comprehensive diagnosis efficiently in a single test. A revealed diagnosis is often not one that has been obvious based on other routine testing, and acting on that diagnosis can be life changing. Many of our patients are revealed to have problems with the autonomic nervous system and blood flow regulation due to long COVID or other systemic diseases. In other tests we find hyperventilation or other abnormal breathing patterns which can be aided by regular breathing exercises. And for other patients with chronic pulmonary emboli, in sharp contrast to Ed鈥檚 reassuring results, we observe a marked increase in pulmonary pressure during exercise which requires changes to their medication regimen.鈥澨�
“You’re handled with care and dealt with professionally.” Ed says.听
These days, Ed is back to enjoying life; golfing, and spending time with his children.听
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