Background: Cardiopulmonary exercise testing (CPET) is a valuable diagnostic and prognostic tool for assessing the integrated function of the cardiopulmonary and muscular systems during exercise. The initiation of a CPET program is complex, and data on early implementation in academic centers remain relatively limited. Objective: to evaluate the initial integration of CPET within a pulmonary department, focusing on patient demographics, referral indications, test performance, and factors associated with anaerobic threshold achievement. Methods: A retrospective cohort study was conducted at a single tertiary care center, including all patients who underwent their first CPET between February 2016 and December 2022. Demographic, clinical, and functional parameters were extracted. Multivariable logistic regression was used to identify variables associated with anaerobic threshold achievement, defined as a respiratory exchange ratio (RER) ≥ 1.1. Results: The cohort included 434 patients (mean age 60.3 ± 14.1 years; 54% male; mean BMI 29.2 ± 5.6 kg/m²). The most common indication for testing was dyspnea (50%). Tests were most frequently terminated due to leg discomfort (39%) and dyspnea (38.8%). Achievement of RER ≥ 1.1 was independently associated with lower BMI (aOR = 0.91; 95% CI: 0.88–0.95; p < 0.001), higher FVC % predicted (aOR = 1.02; 95% CI: 1.00–1.03; p = 0.028), and greater minute ventilation volume (aOR = 1.02; 95% CI: 1.01–1.03; p < 0.001), and it was less likely in patients referred for cardiovascular disease (aOR = 0.37; 95% CI: 0.21–0.64; p < 0.001). No consistent temporal trend in RER achievement was observed across the study period. Conclusions: CPET was most commonly utilized in response to patient-reported dyspnea, with test termination frequently driven by subjective symptoms rather than objective clinical criteria. Anaerobic threshold achievement was more strongly associated with individual physiological characteristics than with institutional experience. These findings underscore the importance of patient preparation and pulmonary functional capacity in optimizing CPET performance.

Background: Chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI) frequently coexist and share several biological pathways and risk factors. Although COPD is associated with worse outcomes after AMI, the prognostic value of objective pulmonary function has not been well characterized. The aim of this study was to evaluate the association between airflow-obstruction severity and five-year all-cause mortality after AMI among patients with COPD. Methods: This single-center retrospective cohort study was restricted to adult post-AMI patients (2002–2017) with a background diagnosis of COPD and documented spirometry; therefore, the final cohort represents a selected subgroup of the source COPD-AMI population. Airflow obstruction was categorized according to forced expiratory volume in one second (FEV1) as Mild, Moderate, Severe, or Very Severe (according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)). The outcome was all-cause mortality during up to five years of follow-up. Results: Among 1594 patients hospitalized with AMI and a COPD diagnosis, 169 patients with available spirometry were included in this selected analytical cohort (mean age 66.76 ± 9.86 years, 76.9% male). During follow-up, 65 patients died, corresponding to an overall five-year mortality rate of 38.5%. Mortality increased progressively across obstruction categories: 19.0%, 33.3%, 40.0%, and 70.8% in Mild, Moderate, Severe, and Very Severe, respectively (p for trend <0.001). In multivariable analysis, adjusted hazard ratios for mortality were: 2.49 (95% CI 0.86–7.24), 3.38 (95% CI 1.09–10.46), and 5.23 (95% CI 1.62–16.89) for Moderate, Severe, and Very Severe, compared with Mild obstruction. Conclusions: Among patients with COPD who survived hospitalization for AMI, more severe airflow obstruction was associated with substantially higher five-year all-cause mortality. These findings support the potential role of spirometry-based risk stratification and highlight the need for integrated cardiopulmonary follow-up after AMI.