Discriminating Circulatory Problems From Deconditioning: Echocardiographic and Cardiopulmonary Exercise Test Analysis

Zach Rozenbaum, Shafik Khoury, Galit Aviram, Yaniv Gura, Jack Sherez, Avi Man, Jason Shimiaie, Thierry Le Tourneau, Amir Halkin, Simon Biner, Gad Keren, Yan Topilsky

Research output: Contribution to journalArticlepeer-review


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-V.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 (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.CO2 slope to V.O2 ratio (≥ 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.CO2 slope to peak V.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 V.E/V.CO2 slope to peak V.O2 ratio. Combining it with ΔV.O2/ΔWR and periodic breathing improves the discriminative ability.

Original languageEnglish
Pages (from-to)431-440
Number of pages10
Issue number2
StatePublished - 1 Feb 2017
Externally publishedYes


  • congestive heart failure
  • echocardiography
  • exercise testing


Dive into the research topics of 'Discriminating Circulatory Problems From Deconditioning: Echocardiographic and Cardiopulmonary Exercise Test Analysis'. Together they form a unique fingerprint.

Cite this