Exercise-Induced Pulmonary Edema in Heart Failure

Agostoni, Piergiuseppe; Cattadori, Gaia; Bianchi, Michele Leonardo; Wasserman, Karlman

doi:10.1161/01.cir.0000097115.61309.59

Cited by 87 publications

(78 citation statements)

References 21 publications

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“…In HF patients, however, despite the fact that pulmonary perfusion (Q) may be significantly reduced, the ability to appropriately recruit Dm for a given Q preserves the Dm/Q ratio and prevents O2 from significant drops 33 . There is, however, documentation that development of subclinical pulmonary edema during exercise is a common finding in HF patients as suggested by a significant and persistent Dm and Dm/Vc reduction during the recovery phase of exercise 53 . This may result in an increased sensation of dyspnea by activation of J receptor afferents, and there is a suggestion that the DM/Q ratio decreases and significant hypoxemia on exercise develops in some post-transplant patients.…”

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confidence: 99%

Endothelial Dysfunction and Lung Capillary Injury in Cardiovascular Diseases

Guazzi¹,

Phillips²,

Arena³

et al. 2015

Progress in Cardiovascular Diseases

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Cardiac dysfunction of both systolic and diastolic origin leads to increased left atrial pressure, lung capillary injury and increased resistance to gas transfer. Acutely, pressure-induced trauma disrupts the endothelial and alveolar anatomical configuration and definitively causes an impairment of cellular pathways involved in fluid-flux regulation and gas exchange efficiency, a process well identified as stress failure of the alveolarcapillary membrane. In chronic heart failure (HF), additional stimuli other than pressure may trigger the true remodeling process of capillaries and small arteries characterized by endothelial dysfunction, proliferation of myofibroblasts, fibrosis and extracellular matrix deposition. In parallel there is a loss of alveolar gas diffusion properties due to the increased path from air to blood (thickening of extracellular matrix) and loss of fine molecular mechanism involved in fluid reabsorption and clearance. Deleterious changes in gas transfer not only reflect the underlying lung tissue damage but also portend independent prognostic information and may play a role in the pathogenesis of exercise limitations and ventilatory abnormalities observed in these patients. Few currently approved treatments for chronic HF have the potential to positively affect structural remodeling of the lung capillary network; angiotensin-converting enzyme inhibitors are one of the few currently established options. Recently, more attention has been paid to novel therapies specifically targeting the nitric oxide pathway as a suitable target to improve endothelial function and permeability as well as alveolar gas exchange properties.

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mentioning

confidence: 99%

Endothelial Dysfunction and Lung Capillary Injury in Cardiovascular Diseases

Guazzi¹,

Phillips²,

Arena³

et al. 2015

Progress in Cardiovascular Diseases

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“…In 25 similar patients, Leite et al 2 reported an average V E/V CO 2 slope of 48.7, which is similar to the 46.6 reported in another study involving 10 patients. 4 Both studies appear far from the V E/V CO 2 slopes of 30 (EOV alone) and 40 (CSA and EOV) reported by Corrà et alThus, in the presence of EOV, a correct V E/V CO 2 slope measure and interpretation should require further mathematical elaboration.These are questions that Corrà et al may help to interpret to further expand our knowledge on the complex and fascinating relationships among exercise ventilation inefficiency, sleep disorders, and life expectancy across different chronic heart failure populations. …”

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confidence: 78%

Letter by Guazzi Regarding Article “Sleep and Exertional Periodic Breathing in Chronic Heart Failure: Prognostic Importance and Interdependence”

Guazzi

2006

Circulation

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I read with interest the article by Corrà and associates 1 that appeared in a recent Circulation issue. In 133 chronic heart failure patients, the authors elegantly demonstrated that those (nϭ22) who exhibit both central sleep apnea (CSA; apnea/ hypopnea index Ն30) and exercise oscillatory ventilation (EOV) have a very unfavorable prognosis. The negative survival expectation is, however, primarily driven by CSA, a recognized prognostic marker, rather than by EOV, a disorder found to be prognostic irrespective of CSA coexistence. 2 Accordingly, patients with isolated EOV had clinical data and survival rates similar to those without oscillatory kinetics. This observation suggests that EOV may not hold clinical importance and weakens the argument for interdependent pathways in the genesis of EOV and CSA. As an overall comment, any reasoning on this category of patients is likely flawed by the small number of subjects investigated (nϭ6).This is the first study in which EOV was tested against exercise V E/V CO 2 slope, a powerful prognosticator in chronic heart failure patients with intermediate performance. 3 Statistical comparison is not reported, and at the multivariate Cox analysis, CSA, peak V O 2 , and ␤-blocker therapy emerged as prognostic, whereas V E/V CO 2 slope, in contrast with established evidence, did not. The information may be misleading in some instances and can be explained by technical difficulties related to the calculation of V E/V CO 2 slope in the setting of oscillatory gas kinetics, including the definition of its linear relationship from the beginning of exercise to the isocapnic compensatory point. The concern is strengthened by the discrepancies among the few studies available. In 25 similar patients, Leite et al 2 reported an average V E/V CO 2 slope of 48.7, which is similar to the 46.6 reported in another study involving 10 patients. 4 Both studies appear far from the V E/V CO 2 slopes of 30 (EOV alone) and 40 (CSA and EOV) reported by Corrà et al.Thus, in the presence of EOV, a correct V E/V CO 2 slope measure and interpretation should require further mathematical elaboration.These are questions that Corrà et al may help to interpret to further expand our knowledge on the complex and fascinating relationships among exercise ventilation inefficiency, sleep disorders, and life expectancy across different chronic heart failure populations. DisclosuresNone.

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“…The main HF symptoms are dyspnea, physical activity intolerance and quality of life reduction [2,3]. HF represents the main cause for hospital ad mission in indiv iduals aging 65 and beyond.…”

Section: Introductionmentioning

confidence: 99%

Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

Pôrto¹,

Kümpel²,

Leite³

et al. 2012

AJMMS

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The aim of this study was to evaluate the effects of a supervised cardiac rehabilitation (CR) program on longterm quality of life (Qo L) of patients with heart failure (HF).Methods: A sample of 21 HF patients, previously sedentary, NYHA II, was randomly divided into two g roups: the CR group (N = 13) and the control group (CG = 8). The CR consisted of sessions of 120 minutes/day, 3 times/week,for 60 days. CR g roup performed their activ ities under supervision at a rehabilitation clinic, and CG received standard care and was instructed to exercise at ho me. All patients underwent a ma xima l sympto m-limited test at the beginning and after 30 and 60 days of CR. Qo L was monitored after 60-days, 6, 12 and 18 months of CR. Results:Two-way A NOVA for repeated measures, follo wed by Tukey's test for statistical analysis showed significantimp rovement in peak VO 2 at 30 and 60-days of CR (p<0.05). Qo L imp roved after 60-days of CR and remained improved throughout the 18following months in the supervised CR group. The use of hospital emergency services became less frequent (p=0.023) and there was a trend for better survival after 18 months of follow-up (p=0.092).Conclusion: CR was effect ive upon cardiopulmonary and Qo L aspects.

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Exercise-Induced Pulmonary Edema in Heart Failure

Abstract: Dm decreases after exercise in HF patients but not in control subjects, which suggests a decrease in conductance across the alveolar-capillary barrier, as with pulmonary edema. The reductions were most marked in HF patients with periodic breathing and less reduced in less severe HF.

Cited by 87 publications

References 21 publications

Endothelial Dysfunction and Lung Capillary Injury in Cardiovascular Diseases

Endothelial Dysfunction and Lung Capillary Injury in Cardiovascular Diseases

Letter by Guazzi Regarding Article “Sleep and Exertional Periodic Breathing in Chronic Heart Failure: Prognostic Importance and Interdependence”

Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

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