Cardiopulmonary exercise testing for the extended aeromedical cardiovascular assessment

EU-Regulation No. 1178/2011 mandates under special circumstances an extended cardiovascular assessment but this is not specified in detail. The German Aeromedical Section requests stress-ECG, echocardiography and Doppler ultrasound of the extracranial vessels as well as numerous lab markers. In current national and European guidelines for the management of stable ischemic heart disease stress-ECG testing is almost obsolete. Stress-echocardiography and stress-MRT have substantially higher diagnostic and prognostic value. Cardiopulmonary exercise testing combines stress-ECG with the measurement of respiratory parameters. With them ischemic disturbances can be detected very sensitively. Diagnostic value of ischemic changes is similar to stress-MRT at significant lower cost. Additionally the negative predictive value of cardiopulmonary exercise testing without signs of ischemia is superb. We therefore propose the use of cardiopulmonary exercise testing to avoid expensive prognostic procedures.