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Entering CPET Data

The Exercise tab is where all cardiopulmonary exercise test data is entered, reviewed, and edited. Data can be entered manually or auto-populated from an imported file.

Demographics and Test Metadata

When a test is loaded (or a new test is started), the top of the Exercise tab shows:

Demographics Summary Bar — A two-row banner at the top of the test view:

• Patient row — Name, age, MRN, height/weight, BMI, diagnosis
• Test row — Date of service, modality, protocol, peak VO₂, peak HR, peak RER

To the right of the chips: a status badge (Preliminary / Verified / Historical), then Verify or Amend, Edit Patient, and Close Test buttons. Click Edit Patient to modify patient-level fields (name, MRN, DOB, sex, race, diagnosis, CNU network IDs). Click Close Test to return to Records without losing data.

Test Metadata Section — Editable fields for the current test session:

Height and weight are entered per test because patients (especially pediatric) may have different measurements at each visit.

Diagnosis on this test

The Diagnosis chip at the bottom of the Test Metadata section shows the diagnosis that applied on this visit's date, which is not necessarily the patient's diagnosis today. Click Edit to open the Diagnosis for this test dialog — the same structured fields as the patient modal (primary diagnosis plus any follow-ups: Fontan ventricular morphology and fenestration status, TOF repair status, CAA type, or an "Other" description).

Editing here changes only this test. The patient's current/default diagnosis — the one shown in Records and used to seed new tests — is edited from Records via Edit Patient.

Why the two are separate: a patient whose Fontan circulation is later replaced by a transplant should not have their 2020 test retroactively relabelled as a transplant patient. Each test keeps a dated snapshot of what was true that day, and REDCap export uses that snapshot.

When a test's diagnosis was inherited rather than entered on that visit, the chip reads (carried forward). The label disappears once you set the diagnosis explicitly.

On a verified test the Edit button is locked along with the rest of the test — click Amend first.

Values carried forward from an earlier visit

Two fields fill themselves in from the patient's history rather than being re-entered every visit: ICD / Pacemaker and Diagnosis. Both show a small (carried forward) note while the value came from somewhere other than this visit.

• The value is taken from the most recent test on or before this test's date of service that recorded one. A device implanted in 2026 never appears on a 2020 test, and carry-forward reaches back past visits that left the field blank.
• Device status has no patient-level default — it comes from prior tests only. Diagnosis falls back to the patient record, but only when no later test contradicts it.
• No, neither is a real answer for ICD / Pacemaker and is carried forward like any other. A blank means nobody has recorded the answer yet, which is a different thing.
• Once you pick a value yourself, it stays. Clearing a carried-forward value leaves it cleared — it is not re-inherited on the next save.

CPET Data Fields

Observed CPET values are organized in a four-column layout by exercise phase:

Rest

Pre-exercise spirometry (if performed): FEV₁, FVC, FEF 25-75%, plus ATS Grade (e.g., AA) and ATS Codes (e.g., BR1R2) per ATS/ERS 2019 acceptability criteria.

Anaerobic Threshold

Peak Exercise

All fields from Rest and AT, plus:

Recovery

Post-exercise spirometry (2-5 min): FEV₁, FVC, FEF 25-75%, plus post ATS Grade and ATS Codes.

Auto-Calculated Fields

Several fields compute automatically as you enter data:

• BMI — From height and weight
• Relative VO₂ (mL/kg/min) — From absolute VO₂ and weight
• O₂ Pulse (mL/beat) — From VO₂ and heart rate
• Age — From date of birth and date of service

You do not need to enter these manually. They update in real time.

Exercise Duration and Termination

At the bottom of the CPET data section:

• Exercise Duration — Enter as minutes and seconds in separate fields (e.g., 12 min 34 sec). Stored internally as total seconds.
• Test Termination Reason — Select from: General / Volitional Fatigue, Leg Fatigue, Dizziness, Shortness of Breath, Chest Pain, Administrator Discretion (Non-Arrhythmia), Administrator Discretion (Arrhythmia), Patient Request, or Other (free-text follow-up appears when Other is selected).

ECG Findings

Structured data entry for exercise ECG findings:

• Sustained atrial tachycardia during exercise? (>30 seconds) — Yes / No
• Ventricular ectopy during exercise? — None / Monomorphic / Polymorphic
  • If present: Sustained or non-sustained?
• Ventricular ectopy during recovery? — None / Monomorphic / Polymorphic
  • If present: Sustained or non-sustained?
• Significant ST segment changes? (≥2mm from baseline) — Yes / No

These findings feed into the auto-generated clinical impression on the Report tab.

Fill Missing / Recompute from BxB

When a test has breath-by-breath data, two buttons appear in the CPET Data section header. Both derive 20+ summary variables (VO₂, HR, VE, VCO₂, VE/VCO₂ slope, etc.) from the BxB stream using the test's averaging method (the site default unless one was chosen for the test):

• Fill Missing from BxB writes only the fields that are empty. Every value already present — imported from the cart or typed — is left exactly as it is.
• Recompute from BxB replaces every Rest / AT / Peak / Recovery value the BxB can provide, plus exercise time and the VE/VCO₂ slopes. AT is taken at the test's AT time; an AT you typed with no AT time on the 9-panel is left alone.

If Breeze already averaged the breath data (a .sum exported with any method other than Unaveraged), both buttons use the rows as exported — they are never averaged a second time — and the header reads, for example, (30s averaging by Breeze).

Both buttons are locked on a verified test; click Amend first.

To recompute many tests at once, use Data Management → Recalculate Summaries from Breath Data (Preliminary and Historical tests, with a preview first), or turn on Recalculate summaries from merged breath data when merging breath data in Bulk Import — see Bulk Import in Depth.

Timing held from a merge. When breath-by-breath data is merged onto a verified test (bulk Merge Mode, the Review queue's Merge, or MedGraphics' missing-breath-data retrieval), the file's exercise/recovery markers and AT time are held, not applied — a blank AT on a verified test may be the reader's decision that no AT could be determined, and nothing should overturn that silently. The held timing takes effect the first time you click either button during an amendment.

Auto-Save and Recovery

Systole auto-saves your work continuously. If the application closes unexpectedly, a recovery banner appears when you reopen it offering to load your unsaved draft. Click Load to pick up where you left off, or Dismiss to start fresh. Tests already linked to the registry auto-recover without needing the banner — the banner only appears for unsaved scratch work.

Test Status and Verification

Every test has a status:

• Click Verify in the demographics summary bar when you are satisfied the data is complete and correct. A "Verified — click Amend to edit" banner appears at the top of each locked section, and all CPET, Reference, and Report fields become read-only.
• Click Amend to unlock a verified test for editing. A confirmation dialog asks for a brief reason; the test reverts to preliminary status with that reason recorded in the audit trail until re-verified.
• Saved exercise prescriptions can still be edited on a verified test (via the Prescription tab's Modify button); narratives and CPET data remain immutable until you Amend.
• Test status is visible in the Records Tests table and affects REDCap export eligibility (only verified tests are exported by default; preliminary tests can be included with an explicit override).

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