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Discriminating Circulatory Problems From Deconditioning: Echocardiographic and Cardiopulmonary Exercise Test Analysis.
- Source :
-
Chest [Chest] 2017 Feb; Vol. 151 (2), pp. 431-440. Date of Electronic Publication: 2016 Oct 11. - Publication Year :
- 2017
-
Abstract
- 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.<br />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.o <subscript>2</subscript> Diff) in four predefined activity levels to assess which of the gas measures may help in the discrimination.<br />Results: Reduced anaerobic threshold (AT), low unchanging peak oxygen pulse, periodic breathing, shallow Δ peak oxygen consumption (V.o <subscript>2</subscript> )/Δwork rate (WR) ratio, and high expired volume per unit time/carbon dioxide production (V. <subscript>e</subscript> /V.co <subscript>2</subscript> ) slope were all associated with abnormal SV response (P < .05 for all). The best discriminator was V. <subscript>e</subscript> /V.co <subscript>2</subscript> slope to V.o <subscript>2</subscript> ratio (≥ 2.7; area under the curve [AUC], 0.79; P < .0001). The optimal gas exchange model included ΔV.o <subscript>2</subscript> /ΔWR < 8.6; V. <subscript>e</subscript> /V.co <subscript>2</subscript> slope to peak V.o <subscript>2</subscript> ratio ≥ 2.7, and periodic breathing (AUC of 0.84; P < .0001).<br />Conclusions: The best single gas exchange parameter to discriminate between circulatory problems and deconditioning is V. <subscript>e</subscript> /V.co <subscript>2</subscript> slope to peak V.O <subscript>2</subscript> ratio. Combining it with ΔV.o <subscript>2</subscript> /ΔWR and periodic breathing improves the discriminative ability.<br /> (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Anaerobic Threshold
Breath Tests
Carbon Dioxide
Diagnosis, Differential
Echocardiography
Female
Heart Failure diagnosis
Humans
Male
Middle Aged
Oxygen Consumption physiology
Ventricular Dysfunction, Left diagnosis
Cardiovascular Deconditioning physiology
Echocardiography, Stress
Exercise Test
Heart Failure physiopathology
Stroke Volume
Ventricular Dysfunction, Left physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1931-3543
- Volume :
- 151
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 27742182
- Full Text :
- https://doi.org/10.1016/j.chest.2016.09.027