Overview

MET-TEST offers an industry first standardized functional capacity assessment with precise serial comparison capabilities to accurately track the status of heart, lung and muscle health over time. This empowers the clinician to effectively monitor the progression of disease and response to therapy to improve future outcomes. All test results are electronically stored in one database. Moreover, the custom developed software in our data center is designed to automatically generate serial comparison reports once it detects that a patient has been previously tested at one of our partner sites. If a patient moves from one locale to another or is transferred from one facility to another, their reports follow them.  The new provider will not need to start from scratch as our reports are highly accurate and reproducible.

CPET technology has been available for decades and the majority of academic centers and hospitals in the country have a metabolic cart available to providers.  To this point in time, the test is used primarily for prognostic purposes (severity of heart failure and timing for heart transplantation) and rarely for diagnostic purposes, even though it is considered the gold standard to determine the cause of shortness of breath.  This is due to the highly demanding nature of the equipment in terms of the need for daily calibration and maintenance as well as the lack of well trained technicians.  If the test is not performed on a daily bases, the technicians will not be proficient in conducting the study.  These issues can result in lack of confidence in the test. Even if the test data is collected properly, very few specialists the world over are proficient in interpreting all aspects of the data to determine the cause of exercise termination.  For example, MET-TEST has helped clinicians diagnose pulmonary emboli and myocardial microcirculation abnormalities (small vessel coronary artery disease) that were missed by other modalities and are rarely reported in CPET studies in other institutions.  MET-TEST is the first entity in the world to report that microvascular ischemia can be detected by CPET1.  Most of these patients have immediate and favorable responses to more potent anti-ischemic medical therapy and can safely undergo exercise as a therapeutic modality to improve their symptoms and functional capacity (a customized exercise prescription is provided with each CPET report). Exercise/Functional capacity is likely the most powerful predictor of all cause mortality2.  This is true in asymptomatic healthy individuals as well as end stage heart failure patients requiring heart transplantation. Exercise capacity is the only currently known prognostic tool to provide insight into the entire spectrum of heart disease.  This is possible because exercise capacity is a physiological parameter versus an imaging or biochemical one and hence is in direct proportion to underlying health status. If the underlying disease process worsens, so will exercise capacity and prognosis.  Thus, tracking exercise capacity is critical to managing chronic heart and lung disease if improving outcomes is a desired goal to improve patient care and to control long term healthcare costs.

In a recent review article in the European Society of Cardiology3, the authors note that:

“Cardiopulmonary exercise testing (CPET) is a methodology that has profoundly affected the approach to patient's functional evaluation, linking performance and physiological parameters to the underlying metabolic substratum and providing highly reproducible exercise capacity descriptors...... The full potentialities of CPET in the clinical and research setting still remain largely underused and strong efforts are recommended to promote a more widespread use of CPET in the functional evaluation of cardiac patients.”

1. Chaudhry S, Ross A, Wasserman K, Hansen JE, Lewis GD, Myers J, Belardinelli R, Labudde B, Menasco N, Boden WE. The utility of cardiopulmonary exercise testing in the assessment of suspected microvascular ischemia. Int J Cardiol 2009.

2. Satoru Kodama; Kazumi Saito; Shiro Tanaka; et al. Cardiorespiratory Fitness as a Quantitative Predictor of All-Cause Mortality and Cardiovascular Events in Healthy Men and Women: A Meta-analysis. JAMA 2009; 301(19):2024-2035.

3. Mezzani A, Agostoni P, Cohen-Solal A, Corra` U, Jegier A, Kouidi E, Mazic S, Meurin P, Piepoli M, Simon A, Laethem CV, Vanhees L. Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2009.

4. Balady GJ et al. Clinician's Guide to Cardiopulmonary Exercise Testing in Adults. A Scientific Statement From the American Heart Association. Circulation. 2010;122:191-225.

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