Revisiting cardiopulmonary exercise testing applications in heart failure: aligning evidence with clinical practice

American Heart Association/American College of Cardiology class recommendations and associated level of evidence for cardiopulmonary exercise testing (CPX) have been put forth. A new paradigm is proposed for CPX use and interpretation in heart failure (HF). Evidence for this new paradigm will be provided, showing that clinical utilization, class recommendations, and the associated level of evidence for CPX in the HF population can be expanded significantly.