title: Discriminating Circulatory Problems From Deconditioning: Echocardiographic and Cardiopulmonary Exercise Test Analysis.
abstract: Discriminating circulatory problems with reduced stroke volume (SV) from deconditioning, in which the muscles cannot consume oxygen normally, by gas exchange parameters is difficult.
  
  
  
  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-V.o2Diff) in four predefined activity levels to assess which of the gas measures may help in the discrimination.
  
  
  
  Reduced anaerobic threshold (AT), low unchanging peak oxygen pulse, periodic breathing, shallow Δ peak oxygen consumption (V.o2)/Δwork rate (WR) ratio, and high expired volume per unit time/carbon dioxide production (V.e/V.co2) slope were all associated with abnormal SV response (P < .05 for all). The best discriminator was V.e/V.co2slope to V.o2ratio (≥ 2.7; area under the curve [AUC], 0.79; P < .0001). The optimal gas exchange model included ΔV.o2/ΔWR < 8.6; V.e/V.co2slope to peak V.o2ratio ≥ 2.7, and periodic breathing (AUC of 0.84; P < .0001).
  
  
  
  The best single gas exchange parameter to discriminate between circulatory problems and deconditioning is V.e/V.co2slope to peak V.O2ratio. Combining it with ΔV.o2/ΔWR and periodic breathing improves the discriminative ability.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Zach
authors.initials: Z
authors.lastname: Rozenbaum
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Shafik
authors.initials: S
authors.lastname: Khoury
authors.affiliation: Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Gura
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Jack
authors.initials: J
authors.lastname: Sherez
authors.affiliation: Department of Pulmonology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Man
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Jason
authors.initials: J
authors.lastname: Shimiaie
authors.affiliation: Division of Cardiovascular Diseases, Universite de Nantes, Nantes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Tourneau
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Halkin
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Simon
authors.initials: S
authors.lastname: Biner
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel. Electronic address: topilskyyan@gmail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
mesh_terms: D000368:Aged; D015308:Anaerobic Threshold; D001944:Breath Tests; D002245:Carbon Dioxide; D018493:Cardiovascular Deconditioning / Q000502:physiology*; D003937:Diagnosis, Differential; D004452:Echocardiography; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology*
chemical_list: D002245:Carbon Dioxide
keywords: congestive heart failure; echocardiography; exercise testing