Gas diffusion and alveolar-capillary unit in chronic heart failure

Agostoni, Piergiuseppe; Bussotti, Maurizio; Cattadori, Gaia; Margutti, Eliana; Contini, Mauro; Muratori, Manuela; Marenzi, Giancarlo; Fiorentini, Cesare

doi:10.1093/eurheartj/ehl302

Cited by 205 publications

(97 citation statements)

References 36 publications

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“…In healthy subjects, aerobic exercise capacity is generally better predicted by DL NO than DL CO , indicating a predominant effect on the membrane component of lung diffusion (51). The same was shown in a study on patients with heart failure (35), although not clearly confirmed (1). The superior prediction of V O 2 max by DL NO compared with DL CO in healthy subjects who are smokers would suggest a predominant role of early vascular disease or ventilation/perfusion mismatch is limiting maximal pulmonary gas exchange.…”

Section: Discussionmentioning

confidence: 71%

“…The diffusing capacities of both gases predicted V O 2 max more significantly in hypoxia. Lung diffusing capacity has been shown to predict aerobic exercise capacity in patients with chronic heart failure (1,35) or with lung diseases (43), but less constantly in healthy subjects with the exception of smokers (41). In healthy subjects, aerobic exercise capacity is generally better predicted by DL NO than DL CO , indicating a predominant effect on the membrane component of lung diffusion (51).…”

Section: Discussionmentioning

confidence: 99%

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Improvement in lung diffusion by endothelin A receptor blockade at high altitude

Bisschop

Martinot

Leurquin‐Sterk³

et al. 2012

Journal of Applied Physiology

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de Bisschop C, Martinot J, Leurquin-Sterk G, Faoro V, Guénard H, Naeije R. Improvement in lung diffusion by endothelin A receptor blockade at high altitude. J Appl Physiol 112: 20 -25, 2012. First published October 6, 2011 doi:10.1152/japplphysiol.00670.2011.-Lung diffusing capacity has been reported variably in high-altitude newcomers and may be in relation to different pulmonary vascular resistance (PVR). Twenty-two healthy volunteers were investigated at sea level and at 5,050 m before and after random double-blind intake of the endothelin A receptor blocker sitaxsentan (100 mg/day) vs. a placebo during 1 wk. PVR was estimated by Doppler echocardiography, and exercise capacity by maximal oxygen uptake (V O2 max). The diffusing capacities for nitric oxide (DLNO) and carbon monoxide (DLCO) were measured using a single-breath method before and 30 min after maximal exercise. The membrane component of DLCO (Dm) and capillary volume (Vc) was calculated with corrections for hemoglobin, alveolar volume, and barometric pressure. Altitude exposure was associated with unchanged DLCO, DLNO, and Dm but a slight decrease in Vc. Exercise at altitude decreased DLNO and Dm. Sitaxsentan intake improved V O2 max together with an increase in resting and postexercise DLNO and Dm. Sitaxsentan-induced decrease in PVR was inversely correlated to DLNO. Both DLCO and DLNO were correlated to V O2 max at sea level (r ϭ 0.41-0.42, P Ͻ 0.1) and more so at altitude (r ϭ 0.56 -0.59, P Ͻ 0.05). Pharmacological pulmonary vasodilation improves the membrane component of lung diffusion in high-altitude newcomers, which may contribute to exercise capacity. altitude; hypoxia; lung diffusion; gas exchange; exercise capacity; pulmonary vascular resistance; pulmonary capillary pressure; pulmonary hypertension BOTH THE MEMBRANE AND THE capillary components of lung diffusing capacity have been shown to be increased in highaltitude residents (10,13,15,25). Increased lung diffusing capacity at high altitude allows for the preservation of gas exchange in the presence of a decreased ventilatory response at exercise (15). High-altitude newcomers do not benefit from this adaptation (10,15,25) and, accordingly, depend on increased ventilation to maintain pulmonary gas exchange (15,45).Previous studies on lung diffusing capacity at high altitudes calculated the membrane and capillary components of alveolocapillary transfer of carbon monoxide (CO) using measurements at ambient air and increased inspired PO 2 (10,13,15,25). This approach rests on the PO 2 dependence of , the blood's specific transfer conductance of CO, in the Roughton and Forster equation, which states that 1/DL CO ϭ 1/Dm ϩ 1/ Vc where DL CO is the diffusing capacity of the lung for CO, Dm its membrane component, and Vc the capillary blood volume (37). Thus changing as by increasing or decreasing inspired PO 2 allows for the calculation of Dm and Vc from a simple system of two equations with two unknowns. However, changing inspired PO 2 might also change pulmonary vascular tone, cardiac output, ...

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Improvement in lung diffusion by endothelin A receptor blockade at high altitude

Bisschop

Martinot

Leurquin‐Sterk³

et al. 2012

Journal of Applied Physiology

View full text Add to dashboard Cite

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“…37 Another study has shown that as V · O2max falls, so does DLCO. 38 Siegel and colleagues found falls in DLCO correlated with reduced EF, but only in those patients found to have rales on clinical examination. 39 Other studies have demonstrated similar reductions in lung volumes and gas transfer, 23,37,40,41 as well as reduced respiratory muscle strength.…”

Section: Effects Of Hf On Respiratory Function Testingmentioning

confidence: 98%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated by its deleterious effects on lung function. HF appears to cause airway obstruction acutely and leads to impaired gas diffusing capacity and pulmonary hypertension in the longer term. It is postulated that this is the result of recurrent episodes of elevated pulmonary capillary pressure leading to pulmonary oedema and pulmonary capillary stress fracture, which produces lung fibrosis. It is likely that impaired lung function impairs the functional status of HF patients and makes them more prone to central sleep apnoea. (Circ J 2010; 74: 2507 - 2516

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“…In these patients, there is decreased pulmonary function, including forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), and forced expiratory flow at 25–75% of FVC (FEF 25–75 ); decreased diffusing capacity for carbon monoxide (DLCO); and altered gas exchange at both rest and exercise 9, 10, 11. However, the degree to which these functional variables may be modified by therapeutic intervention during an acute decompensation and recovery during a course of inpatient treatment has not been well characterized.…”

Section: Introductionmentioning

confidence: 99%

The effect of diuresis on extravascular lung water and pulmonary function in acute decompensated heart failure

et al. 2018

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AimsThe effect of extravascular lung water (EVLW) and relationship to functional status as a result of acute decompensated heart failure (ADHF) are not well understood. We sought to quantify changes in clinical variables, EVLW, airway anatomy, spirometry, and diffusing capacity for carbon monoxide before and after treatment for ADHF.Methods and resultsFifteen patients were recruited within 24 h of hospital admission. Spirometry, diffusing capacity for carbon monoxide, and surrogates of EVLW by computed tomography were measured and were then repeated within 24 h of discharge. From the computed tomography (CT) scan, surrogates of EVLW were calculated from the distribution of CT attenuation of the lung tissue. Airways were segmented using the vida apollo software. Patients were hospitalized for 4.6 ± 2.1 days, had 10 ± 4.8 L of fluid removed (7.0 ± 4.2 L between study visits), and lost 7.1 ± 4.9 kg. Patients had significant clearance of fluid from the lungs (per cent change: mean, 4.2 ± 6.1%; skew, 17.5 ± 27.0%; kurtosis, 37.6 ± 56.7%; full‐width half‐maximum, 10.2 ± 13.5%). Static lung volumes and maximal flows improved significantly (per cent change: forced vital capacity, 14.5 ± 13.6%; forced expiratory volume in 1 s, 15.9 ± 14.0%; forced expiratory flow at 25–75% of forced vital capacity, 27.2 ± 42.9%). The ratio of membrane conductance to capillary blood volume improved significantly (per cent change: alveolar–capillary membrane conductance/capillary blood volume, 23.4 ± 22.8%). Weight loss during hospitalization was significantly correlated with improved spirometry and diffusing capacity.ConclusionsExtravascular lung water contributes to the pulmonary congestive syndrome in ADHF patients, and its clearance is an important component of the improvement in pulmonary function as a result of inpatient treatment.

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Gas diffusion and alveolar-capillary unit in chronic heart failure

Cited by 205 publications

References 36 publications

Improvement in lung diffusion by endothelin A receptor blockade at high altitude

Improvement in lung diffusion by endothelin A receptor blockade at high altitude

Heart Failure and the Lung

The effect of diuresis on extravascular lung water and pulmonary function in acute decompensated heart failure

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