Cardiopulmonary Exercise Testing in Elderly Patients with Cardiopulmonary Comorbidities: Safety and Clinical Feasibility

Background/Objectives: Cardiopulmonary exercise testing (CPET) provides an integrated assessment of cardiovascular, respiratory, and metabolic responses during exercise. Although CPET is increasingly used in older adults for preoperative physiological evaluation and assessment of exercise limitation, evidence regarding its safety and clinical feasibility in elderly patients with mixed cardiopulmonary comorbidities remains limited. Methods: In this retrospective observational study, we evaluated 235 consecutive patients who underwent CPET at a tertiary referral center. Patients were categorized into two groups according to age: ≥65 years and <65 years. Clinical characteristics, pulmonary function parameters, CPET findings, feasibility outcomes, and adverse events during testing were analyzed. Results: A total of 235 patients were included, with a mean age of 62.3 ± 12.8 years. Among them, 112 (47.6%) patients were aged ≥65 years and 35 (14.8%) were aged ≥75 years. Comorbidities were present in 170 patients, with hypertension being the most common. The leading indication for CPET was preoperative evaluation prior to thoracic surgery. Most elderly patients successfully completed CPET and provided clinically interpretable physiological data. In the ≥65 years group, CPET was terminated prematurely in 10 patients due to syncope, severe dyspnea, bronchospasm, chest pain, or arrhythmia. In the ≥65 years group, exercise-induced desaturation occurred in 24 patients; the lowest recorded oxygen saturation was 84%, and no desaturation episode required premature termination of the test. No major complications, deaths, myocardial infarctions, or cardiac arrests were observed during CPET or within the subsequent three days. No statistically significant differences in adverse event rates were observed between the age groups. Univariate logistic regression analysis demonstrated that lower FEV1 % predicted and lower FEV1/FVC % predicted ratio were associated with clinically significant adverse events in elderly patients OR (95% CI): 0.96 (0.94–0.99), p = 0.02, OR (95% CI): 0.90 (0.84–0.96), p = 0.001, respectively. Conclusions: CPET was feasible in the majority of elderly patients with cardiopulmonary comorbidities, with most individuals successfully completing testing and providing clinically interpretable physiological data. No major complications were observed in this cohort. These findings suggest that, when performed under appropriate supervision and careful patient selection, CPET may represent a practical tool for functional assessment and preoperative physiological evaluation in older adults. Larger prospective multicenter studies are warranted to further define its safety and feasibility in this population.