Heart Disease Reconsidered: Using an iCPET and Metabolic Cart to Evaluate Oxygen Saturation Between the Heart and Lungs instead of a Pulse Oximeter Fingertip Reading
 
70% of the heart disease in the world is not adequately diagnosed, properly understood, or treated.  This is because the gold standard for heart diagnosis, the standard stress test, diagnoses heart blockages but not PAH.  Chronic fatigue, long term Covid are not diagnosed by any of the following standard hearth disease tests.  Dyspneic patient evaluations mostly do not show a definitive diagnosis. 
 
Dyspneic patients without an obvious primary etiology and heart patients with heart failure are often told to walk for a certain time and then the pulse oximeter reading is the current gold standard for diagnosis.  Medicare only reimburses oxygen for treatment based on the pulse oximeter readings.  Patients with exercise intolerance may be referred to a number of different specialists for evaluation. 
 
Current Heart Patient Initial Evaluation Testing:
Extensive blood work
Pulmonary function testing
Echocardiography
Cardiac catheterization
Radiographic imaging
Nuclear imaging modalities
Cardiac stress testing
Cardiopulmonary exercise testing (CPET) noninvasive, not catheterization, just stress test exercise machine 
Source:  WinterGreen Research, Inc.  
 
Patients may undergo 20 or more tests as per the above list with no definitive diagnosis: only the iCPET that uses a metabolic cart instead of a pulse oximeter to diagnose PAH definitively.  The PAH diagnosis from iCPET is definitive enough of PAH to get insurance reimbursement, while the other tests listed  above do not provide a definitive diagnosis. 
 
An iCPET test provides more accurate measure of blood oxygen gas than a pulse oximeter, because the pulse oximeter only measures oxygen attached to the hemoglobin, and the organs utilize oxygen in the blood, blood oxygen gas different from hemoglobin oxygen in many cases.    
 
Two new studies from WinterGreen Research address the difference between the standard heart tests and iCPET that uses a metabolic cart and catheterization to diagnose heart disease PAH.  The research indicates that Medicare needs to re-evaluate its standards for prescription of intermittent supplemental oxygen as applied to PAH. 
 
Fatigue, shortness of breath and lightheadedness upon exertion have new types of iCPET cardiac testing that give more incisive insight into combined heart and lung functioning.  Invasive cardiopulmonary exercise testing gives a more precise view of cardiac function.   
 
Results of an invasive cardiopulmonary exercise test (iCPET) explain more about patient heart-lung connectivity conditions than the above list of tradition heart disease testing.  With long-haul COVID and heart failure involving lung artery or venous failure, new diagnostic tools are expected to provide new treatments.               
 
The emerging PAH testing and treatment equipment market is being built on an until now vastly underutilized test: iCPET.  Increased utilization of iCPET is creating the opportunity to diagnose and treat 2.05 billion patients with heart disease who are not now being treated or who are living undertreated.  This represents a huge new market for portable oxygen concentrators should the industry be able to get reimbursement for the use of supplemental oxygen to treat PAH, no mean feat.
 
Heart patients with obstructions are now being treated for blockages, but the vast majority of people have an inter-organ PAH difficulty and are not being treated adequately, largely because they are underdiagnosed. 
 
Pulmonary arterial hypertension (PAH), high blood pressure in the lungs, is characterized by exercise intolerance.  A recently embraced test iCPET has been able to document the presence of chronic fatigue syndrome so that patients can actually collect disability insurance, a hitherto virtual impossibility.  The more recently used invasive test, iCPET can detect that during intense exercise, a decline in mixed venous oxygen saturation (SvO2) is the defining characteristic of the hypertension, leading to an ability to perform diagnosing a disease PAH. 
 
Then the need is to treat the organs which have deficient supply of oxygen during exercise, indicating the need for supplemental oxygen in an intermittent manner. 
Heart disease reconsidered means that the 70% of people with nonblockage heart disease have an opportunity for diagnosis using an iCPET and metabolic cart to evaluate oxygen saturation between the heart and lungs. 
 
Instead of a pulse oximeter fingertip reading that does not always catch low oxygen gas in the veins and arteries between the heart and lungs, it is necessary to use an internal catheter to measure directly the lack of oxygen inside the body.  In this manner is ti possible to detect a lack of oxygen being sent to the organs using an iCPET.