CPET Characteristics in HFrEF, HFpEF and COPD

Chronic obstructive pulmonary disease (COPD) frequently occurs alongside heart failure (HF), including heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), creating a diagnostic dilemma due to overlapping clinical manifestations such as exertional dyspnea and reduced exercise tolerance. Static diagnostic modalities are often insufficient to distinguish these entities or their overlapping syndromes (HFrEF-COPD and HFpEF-COPD). Cardiopulmonary exercise testing (CPET) uniquely provides a dynamic, integrated assessment of the respiratory, cardiovascular, and peripheral muscle systems during incremental exercise, enabling quantitative characterization of the pathophysiological mechanisms underlying exercise limitation. This review comprehensively summarizes the characteristic CPET profiles of isolated HFrEF, isolated HFpEF, isolated COPD, HFrEF-COPD, and HFpEF-COPD. Integration of CPET parameters with pulmonary function testing results in a comprehensive assessment of the cardiopulmonary system, facilitating accurate diagnosis and prognostic stratification in this complex patient population. Finally, we address current limitations in standardization and outline future directions for advancing precision medicine in this complex clinical landscape.