Cardiopulmonary exercise testing (CPET) is safe for investigating pulmonary hypertension (PH) and should be routinely used, long-term, real-world data suggests.

Across ten years at a UK centre, researchers reported no deaths or syncopal events from incremental, symptom-limited CPET, with an adverse event rate of just 0.05%.

“When performed under appropriate supervision, CPET should be regarded as a routine and low risk investigation in PH,” wrote the authors, led by Dr Andrea Baccelli, a clinical research fellow at Imperial College London.

“Our results reinforce international guideline recommendations and provide the largest dataset to date supporting the safety of CPET in this population,” they added.

The study, published in the European Respiratory Journal [link here], analysed 3,867 symptom-limited, incremental CPETs performed in 2,682 patients (mean age 57 years; 55% female) with suspected or confirmed PH at the UK’s Hammersmith Hospital between January 2015 and August 2025.

CPET was contraindicated if patients had a recent syncope, were unable to cycle, or needed oxygen at rest.

Across all tests, there were only two adverse events:

• A 74-year-old female with chronic thromboembolic pulmonary hypertension (CTEPH) who was admitted to hospital after developing transient anterior ST segment elevation and mild chest discomfort at peak exercise; and
• A 73-year-old male with CTEPH who developed reversible anterior ST elevation and was subsequently found to have a significant mid-left anterior descending coronary artery lesion which was treated with stenting.

Both patients made full recoveries.

Nearly all CPETs (98.5%) were terminated by patients due to fatigue or dyspnoea, while 56 (1.5%) were stopped by monitoring staff due to dizziness (n=22), oxygen desaturation (n=12), increased ventricular ectopy (n=8), vasovagal episodes (n=6), abnormal blood pressure response (n=6) or transient ST-segment elevation (n=2).

“The absence of serious events in nearly 4,000 studies performed over a decade supports the view that incremental, symptom-limited CPET is safe and feasible in both suspected and confirmed PH,” the authors concluded.

“Importantly, 33% of our cohort were aged ≥ 65 years, highlighting that advanced age alone should not preclude testing when adequate supervision and monitoring are ensured,” they added.