Lung diffusion capacity in advanced heart failure: relation to central haemodynamics and outcome

Abstract

Aims Patients with heart failure (HF) are known to have a reduced pulmonary diffusion capacity for carbon monoxide (D LCO ), but little is known about how lung function relates to central haemodynamics. The aim of this study was to investigate the association between haemodynamic variables and pulmonary diffusion capacity adjusted for alveolar volume in congestive HF patients and to analyse how predicted D LCO /V A affects mortality in relation to the haemodynamic status. Methods and results We retrospectively studied right heart catheterization (RHC) and lung function data on 262 HF patients (mean age 51 ± 13 years) with a left ventricular ejection fraction < 45% referred non‐urgently for evaluation for heart transplantation (HTX) or left ventricular assist device (LVAD). Univariate and multivariate linear regression models were constructed to examine the associations between predicted values of D LCO /V A , forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ), and haemodynamic parameters [pulmonary capillary wedge pressure (PCWP), central venous pressure, cardiac index, mean pulmonary artery pressure, and mean arterial pressure] as well as other factors known to affect lung function in HF. FEV 1 was reduced to <80% of predicted value in 55% of the population, and D LCO/ V A was reduced in 63% of the population. D LCO /V A correlated positively with pulmonary capillary wedge pressure in both univariate and multivariate analyses for all included patients ( P < 0.001 and P = 0.045, respectively) and a restricted population of patients with the shortest time between RHC and lung function testing ( P = 0.005, P = 0.015). D LCO /V A predicted mortality in multivariate models [hazard ratio 1.5 (1.1–2.1)] but not the combined endpoint of death, LVAD implantation, or HTX. There was no significant correlation between haemodynamics and predicted FVC or FEV 1 . Conclusions Pulmonary diffusion capacity correlates positively with left ventricular fillings pressures, and reduced values predict increased mortality in patients with HF. This might be driven by increased lung capillary volume in patients with pulmonary congestion.

Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study

“…Heart failure can restrict lung volumes though pulmonary congestion, resulting in a reduced D LCO . Pulmonary congestion usually increases capillary blood volume, possibly contributing to the higher D LCO /V A values [40,45]. We showed that subjects with incident PRISm had a concomitant increase in BMI, independent of incident heart failure.…”

Influence of reduced diffusing capacity and FEV1 on outcome after cardiac surgery

“…DLCO is reduced in patients with emphysema, pulmonary fibrosis, pulmonary hypertension, heart failure, mitral stenosis, and pulmonary oedema. [9][10][11][12] In this respect, patients with progressive heart failure have reduced DLCO, 9,10,13,14 and this decline in DLCO is associated with increased all-cause mortality. 13,15 In contrast, impairment of DLCO in patients with COPD is not associated with increased mortality.…”

“…[9][10][11][12] In this respect, patients with progressive heart failure have reduced DLCO, 9,10,13,14 and this decline in DLCO is associated with increased all-cause mortality. 13,15 In contrast, impairment of DLCO in patients with COPD is not associated with increased mortality. [16][17][18] The association of reduced DLCO on outcome in cardiac surgery patients has only been explored in a few studies, including preselected groups of symptomatic patients with a history of smoking or use of bronchodilator/steroid treatment, and in this context, DLCO was associated with a worse outcome.…”

Variability in pulmonary diffusing capacity in heart failure

“…There is a higher mortality risk and poor prognosis in patients with heart failure that have low diffusing capacities (Deis et al, 2019;Hoeper et al, 2016;Nakamura et al, 2019). Thus, pulmonary function testing can sometimes occur frequently to help with patient management.…”

“…As pulmonary diffusing capacity is related to mortality risk and prognosis in patients with heart failure (Deis et al, 2019;Hoeper et al, 2016;Nakamura et al, 2019), it is measured frequently. As such, it would be essential to know the week-to-week variability (reproducibility) of pulmonary diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO).…”