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Original Research |

Discriminating Circulatory Problems from Deconditioning - Echocardiogram and Cardio-Pulmonary Exercise Test Analysis

Zach Rozenbaum, MD; Shafik Khoury, MD; Galit Aviram, MD; Yaniv Gura, MD; Jack Sherez, BSc; Avi Man, MD; Jason Shimiaie, MD; Thierry Le Tourneau, MD; Amir Halkin, MD; Simon Biner, MD; Gad Keren, MD; Yan Topilsky, MD
Author and Funding Information

Al authors have no conflict of interest.

The Division of Cardiovascular Diseases and Internal Medicine

The Division of radiology

Pulmonology department Tel Aviv Medical Center, Tel Aviv, Israel

∗∗The Division of Cardiovascular Diseases Universite de Nantes

Address for Correspondence: Yan Topilsky, M.D., Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.09.027
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Published online

Abstract

Background  Discriminating circulatory problems with reduced stroke volume from de-conditioning in which the muscles cannot consume O2 normally by gas exchange parameters is difficult.

Methods  We performed combined stress echo and cardio-pulmonary (CPET) tests in 110 patients (20 normal effort capacity, 54 attenuated stroke volume response, 36 de-conditioning) to evaluate multiple hemodynamic parameters and oxygen content difference (A-VO2 Difference) in four predefined activity levels to assess which of the gas measures may help in the discrimination.

Results  Reduced anaerobic threshold (AT), low unchanging peak O2 pulse, periodic breathing, shallow ΔVO2/Δ work rate (WR) ratio, and high VE/VCO2 slope were all associated with abnormal stroke volume response (p<0.05 for all). The best discriminator was VE/VCO2 slope to peak VO2 ratio (≥2.7; AUC 0.79: p<0.0001). The optimal gas exchange model included ΔVO2/Δ work rate<8.6, VE/VCO2 slope to peak VO2 ratio ≥2.7, and periodic breathing (AUC of 0.84, p<0.0001).

Conclusion  The best single gas exchange parameter to discriminate between circulatory problems to de-conditioning is VE/VCO2 slope to peak VO2 ratio.


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