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Original Research: Pulmonary Physiology |

Discriminating Circulatory Problems From Deconditioning: Echocardiographic and Cardiopulmonary 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

Z. R. and S. K. have contributed equally to the study.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDivision of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel

bDivision of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel

cDepartment of Pulmonology, Tel Aviv Medical Center, Tel Aviv, Israel

dSackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel

eDivision of Cardiovascular Diseases, Universite de Nantes, Nantes, France

CORRESPONDENCE TO: Yan Topilsky, MD, Division of Cardiovascular Diseases and Internal Medicine, Sackler Faculty of Medicine, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, Israel


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(2):431-440. doi:10.1016/j.chest.2016.09.027
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Background  Discriminating circulatory problems with reduced stroke volume (SV) from deconditioning, in which the muscles cannot consume oxygen normally, by gas exchange parameters is difficult.

Methods  We performed combined stress echocardiography (SE) and cardiopulmonary exercise tests (CPET) in 110 patients (20 with normal effort capacity, 54 with attenuated SV response, and 36 with deconditioning) to evaluate multiple hemodynamic parameters and oxygen content difference (A-o2 Diff) 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 oxygen pulse, periodic breathing, shallow Δ peak oxygen consumption (o2)/Δwork rate (WR) ratio, and high expired volume per unit time/carbon dioxide production (e/co2) slope were all associated with abnormal SV response (P < .05 for all). The best discriminator was e/co2 slope to o2 ratio (≥ 2.7; area under the curve [AUC], 0.79; P < .0001). The optimal gas exchange model included Δo2/ΔWR < 8.6; e/co2 slope to peak o2 ratio ≥ 2.7, and periodic breathing (AUC of 0.84; P < .0001).

Conclusions  The best single gas exchange parameter to discriminate between circulatory problems and deconditioning is e/co2 slope to peak O2 ratio. Combining it with Δo2/ΔWR and periodic breathing improves the discriminative ability.

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