The Influence of Chronic Heart Failure on Pulmonary Function Tests in Patients Undergoing Orthotopic Heart Transplantation

Lizak, M.K.; Zakliczyńśki, Michał; Jarosz, Anna; Zembala, Marian

doi:10.1016/j.transproceed.2009.07.072

Cited by 19 publications

(18 citation statements)

References 13 publications

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“…showed that FVC, FEV 1 , and DLCO can be used to predict outcomes in specific heart failure patients . Others have shown similar findings . It is thought that posttransplantation elimination of cardiomegaly, decrease in left ventricular end‐diastolic pressure, decompression of the pulmonary circulation, and reverse remodeling of PVR may partly explain the improvement in PFT in heart transplant recipients .…”

Section: Discussionmentioning

confidence: 82%

Changes in Spirometry After Left Ventricular Assist Device Implantation

et al. 2015

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Left ventricular assist devices (LVADs) are increasingly being used as life-saving therapy in patients with end-stage heart failure. The changes in spirometry following LVAD implantation and subsequent unloading of the left ventricle and pulmonary circulation are unknown. In this study, we explored long-term changes in spirometry after LVAD placement. In this retrospective study, we compared baseline preoperative pulmonary function test (PFT) results to post-LVAD spirometric measurements. Our results indicated that pulmonary function tests were significantly reduced after LVAD placement (forced expiratory volume in one second [FEV1 ]: 1.9 vs.1.7, P = 0.016; forced vital capacity [FVC]: 2.61 vs. 2.38, P = 0.03; diffusing capacity of the lungs for carbon monoxide [DLCO]: 14.75 vs. 11.01, P = 0.01). Subgroup analysis revealed greater impairment in lung function in patients receiving HeartMate II (Thoratec, Pleasanton, CA, USA) LVADs compared with those receiving HeartWare (HeartWare, Framingham, MA, USA) devices. These unexpected findings may result from restriction of left anterior hemi-diaphragm; however, further prospective studies to validate our findings are warranted.

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Section: Discussionmentioning

confidence: 82%

Changes in Spirometry After Left Ventricular Assist Device Implantation

et al. 2015

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“…; Lizak et al. ). However, in both the control and HF groups, the airway luminal area in at least one generation was significantly related to each of the four spirometry variables, FEV 1 , FVC, FEF 25–75 , and PEF at baseline.…”

Section: Discussionmentioning

confidence: 98%

Impact of chronic systolic heart failure on lung structure-function relationships in large airways

et al. 2016

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Heart failure (HF) is often associated with pulmonary congestion, reduced lung function, abnormal gas exchange, and dyspnea. We tested whether pulmonary congestion is associated with expanded vascular beds or an actual increase in extravascular lung water (EVLW) and how airway caliber is affected in stable HF. Subsequently we assessed the influence of an inhaled short acting beta agonist (SABA). Thirty‐one HF (7F; age, 62 ± 11 years; ht. 175 ± 9 cm; wt. 91 ± 17 kg; LVEF, 28 ± 15%) and 29 controls (11F; age; 56 ± 11 years; ht. 174 ± 8 cm; wt. 77 ± 14 kg) completed the study. Subjects performed PFTs and a chest computed tomography (CT) scan before and after SABA. CT measures of attenuation, skew, and kurtosis were obtained from areas of lung tissue to assess EVLW. Airway luminal areas and wall thicknesses were also measured. CT tissue density suggested increased EVLW in HF without differences in the ratio of airway wall thickness to luminal area or luminal area to TLC (skew: 2.85 ± 1.08 vs. 2.11 ± 0.79, P < 0.01; Kurtosis: 15.5 ± 9.5 vs. 9.3 ± 5.5 P < 0.01; control vs. HF). PFTs were decreased in HF at baseline (% predicted FVC:101 ± 15% vs. 83 ± 18%, P < 0.01;FEV1:103 ± 15% vs. 82 ± 19%, P < 0.01;FEF25–75: 118 ± 36% vs. 86 ± 36%, P < 0.01; control vs. HF). Airway luminal areas, but not CT measures, were correlated with PFTs at baseline. The SABA cleared EVLW and decreased airway wall thickness but did not change luminal area. Patients with HF had evidence of increased EVLW, but not an expanded bronchial circulation. Airway caliber was maintained relative to controls, despite reductions in lung volume and flow rates. SABA improved lung function, primarily by reducing EVLW.

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“…Constriction of the bronchial vasculature with methoxamine was shown to improve exercise tolerance in subjects with chronic, stable HF highlighting the importance of bronchial circulation in this population [13, 14]. In healthy subjects, rapid fluid loading has been shown to reduce lung volumes and forced expiratory flows, while heart transplant in patients with severe disease, subsequently reducing pulmonary pressures, improves these same measures, suggesting that either thoracic blood volumes or EVLW may contribute to changes in lung function [15, 16]. Additionally, the heart and lungs must compete for space within the thoracic cavity, where cardiomegaly and/or other changes in vascular beds may impinge on the ability of the lungs to expand [17].…”

Section: Introductionmentioning

confidence: 99%

Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure

Chase

Taylor

Cross

et al. 2017

Journal of Cardiac Failure

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Introduction Pulmonary congestion is a common finding of heart failure (HF), but it remains unclear how pulmonary and heart blood volumes (Vp and Vh) and extravascular lung water (EVLW) change in stable HF and impact lung function. Methods Fourteen patients with HF (age: 68±11 y; LVEF: 33±8%) and 12 controls (age: 65±9 y) were recruited. A pulmonary function test, thoracic CT scan, and contrast perfusion scan were performed. From the thoracic scan, a histogram of CT attenuation of lung tissue was generated and skew, kurtosis, and full-width half-max were calculated as surrogates of EVLW. Blood volumes were calculated from the transit time of the contrast through the great vessels of the heart. Results Patients with HF had greater Vp and Vh (Vp: 0.55±0.21 l v.s 0.41±0.13 l; Vh: 0.53±0.33 l vs. 0.40±0.15 l) and EVLW (skew: 3.2±0.5 vs. 3.7±0.7; kurtosis: 19.4±6.6 vs. 25.9±9.4; FWHM: 73±13 vs 59±9Hu). Spirometric measures were decreased in HF (%-predicted FVC: 86±17% vs. 104±9%; FEV1: 83±20% vs. 105±11%; FEF25–75: 82±42% vs. 115±43%). Vp was associated with decreased expiratory flows, while EVLW was associated with decreased lung volumes. Conclusions Congestion in stable patients with HF includes expanded Vp and increased EVLW associated with reductions in lung volumes and expiratory flows.

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The Influence of Chronic Heart Failure on Pulmonary Function Tests in Patients Undergoing Orthotopic Heart Transplantation

Cited by 19 publications

References 13 publications

Changes in Spirometry After Left Ventricular Assist Device Implantation

Changes in Spirometry After Left Ventricular Assist Device Implantation

Impact of chronic systolic heart failure on lung structure-function relationships in large airways

Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure

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