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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Exercise testing with ventilatory gas analysis Class I - There is evidence and/or general agreement that exercise testing with ventilatory gas analysis should be performed in the following settings: • To evaluate exercise capacity and the response to therapy in patients with heart failure who are being considered for heart transplantation. • To assist in the differentiation between cardiac and pulmonary causes of exercise-induced dyspnea or impaired exercise capacity when the cause is uncertain. Class IIa - The weight of evidence or opinion is in favor of the usefulness of exercise testing with ventilatory gas analysis in the following setting: • To evaluate exercise capacity when indicated for medical reasons when estimated exercise capacity from exercise test time or work rate is unreliable. Class IIb - The weight of evidence or opinion is less well established for the usefulness of exercise testing with ventilatory gas analysis in the following settings: • To evaluate the response to specific therapeutic interventions when improvement in exercise tolerance is important goal or end point. • To determine the intensity for exercise training as part of comprehensive cardiac rehabilitation. Class III - There is evidence and/or general agreement that exercise testing with ventilatory gas analysis is not useful in the following setting: • Routine use to assess exercise capacity. Data from Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002; 106:1883.