Ventilatory and Diffusion Abnormalities in Potential Heart Transplant Recipients

Wright, Robert; Levine, Michael S.; Bellamy, Paul E.; Simmons, Michael; Batra, Poonam; Stevenson, Lynne Warner; Walden, Julie; Laks, Hillel; Tashkin, Donald P.

doi:10.1378/chest.98.4.816

Cited by 119 publications

(92 citation statements)

References 16 publications

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“…14 Our study showed a greater impaired FEV 1 /VC ratio in subjects who had smoked Ն10 packyears. Also, having smoked Ն10 pack-years was a significant predictor of airway obstruction, but this depended on the definition used to define airway obstruction.…”

Section: Discussionsupporting

confidence: 48%

“…[4][5][6][7]13 However, results are not consistent among the studies. For example, although smoking and a history of coronary artery bypass grafting were associated with more impaired pulmonary function in the study of Johnson et al, 13 with also weak associations between left ventricular function and both lung volumes as well as diffusing capacity, none of the described pulmonary function abnormalities were found to be related to either smoking status, use of cardiac drugs, chest radiographic changes, hemodynamic findings, or clinical features, including the duration of heart failure in the study of Wright et al 14 Misdiagnosis of pulmonary function abnormalities may have interfered with the interpretation of prior research aiming to investigate the impact of heart failure and several clinical variables on pulmonary function in this group of patients. Traditionally, the 80% predicted value and the fixed ratio of FEV 1 /FVC Ͻ0.7 have been used to define pulmonary function abnormalities.…”

Section: Introductionmentioning

confidence: 83%

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Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure

Minasian¹,

Elshout²,

Dekhuijzen

et al. 2015

Respir Care

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BACKGROUND: Using the newer lower limit of normal criterion instead of the conventional cutoff values to define pulmonary function abnormalities may result in different predictors of pulmonary function impairment in patients with heart failure. Therefore, we assessed predictors of pulmonary function impairment in subjects with chronic heart failure according to the lower limit of normal in comparison with conventional cutoff values. METHODS: In this prospective cross-sectional study, 164 chronic heart failure subjects (age 68 ؎ 10 y, 78% men, 88% New York Heart Association class I-II) with left ventricular ejection fraction <40% underwent pulmonary function tests. Predictors of pulmonary function impairment were assessed using the lower limit of normal and conventional cutoff values (ie, 80% predicted value and the fixed ratio of FEV 1 /FVC <0.7). RESULTS: The lower limit of normal criterion identified an extra independent predictor of diffusion impairment compared with the 80% predicted value; in addition to body mass index, pack-years, and alveolar volume, female sex also turned out to be an independent predictor. A smoking history of >10 pack-years was a significant predictor of diffusion impairment and airway obstruction using the lower limit of normal criterion but not using the conventional cutoff values. However, lowering the cutoff points of conventional criteria to match the more stringent lower limit of normal and thus avoid overdiagnosis of diffusion impairment and airway obstruction in the elderly produced similar results as the lower limit of normal. CONCLUSIONS: The lower limit of normal identifies more predictors of diffusion impairment and airway obstruction compared with conventional cutoff values in subjects with chronic heart failure with left ventricular systolic dysfunction. However, lowering the conventional cutoff points yielded similar results as the lower limit of normal. (ClinicalTrials.gov registration NCT01429376.) Key words: Chronic heart failure, conventional cutoff values, lower limit of normal, predictors, pulmonary function impairment. [Respir Care 2016;61(2):173-183.

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Section: Discussionsupporting

confidence: 48%

Section: Introductionmentioning

confidence: 83%

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure

Minasian¹,

Elshout²,

Dekhuijzen

et al. 2015

Respir Care

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“…A retrospective study assessed 132 patients being evaluated for heart transplant who had undergone pulmonary function testing. 36 These patients had a mean ejection fraction of 19% and a cardiac index of 2.1 L · min -1 · m -2 . The mean duration of HF in this cohort was 3.4 years.…”

Section: Effects Of Hf On Respiratory Function Testingmentioning

confidence: 95%

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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“…Preoperatively, they may have received amiodarone, and up to one third of patients awaiting transplantation are recognized as having pulmonary diffusion impairment [9], possibly resulting from chronic pulmonary congestion.…”

mentioning

confidence: 99%

Pulmonary diffusion impairment following heart transplantation: a prospective study

Egan

Lowe²,

Yonan³

et al. 1996

Eur Respir J

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The aim of this prospective study was to confirm whether and when a fall in gas transfer occurs following heart transplantation (HT); and to examine the potential relationship between gas transfer and haemodynamic change, immunosuppression, and cytomegalovirus (CMV) infection.The lung physiology of 34 heart transplant recipients (HTR) and 14 control patients undergoing coronary artery bypass grafting (CABG) were studied. The absolute and standardized residual values of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), residual volume (RV), forced residual volume (FRC), total lung capacity (TLC), transfer factor of the lungs for carbon monoxide (TL,CO) and carbon monoxide transfer coefficient (KCO) were measured before and at 30, 60, 90, 120 and 150 days after HT. These data were compared to haemodynamic status, graft rejection, cyclosporin levels and episodes of CMV infection. Lung function was studied in a group of patients before and 4 weeks after CABG.There was a significant fall in mean KCO after HT (pre-HT=1.29 and post-HT= 1.06 mmol·min -1 ·kPa·L -1 ) but not after CABG (pre-CABG=1.49, post-CABG=1.5 mmol·min -1 ·kPa·L -1 . No relationship was observed between gas transfer and CMV.At the latest stage following HT (150 days) there was a positive correlation between TL,CO (absolute value and standardized residual) and mean cyclosporin level (r=0.48 and r=0.44, respectively) and also between the absolute KCO and actual (r=0.56) and mean (r=0.55) cyclosporin levels. Following HT, there is an early fall in gas transfer, which is independent of the effects of surgery and bypass, implicating early immunosuppression (e.g. antithymocyte globulin/cyclosporin).

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Ventilatory and Diffusion Abnormalities in Potential Heart Transplant Recipients

Cited by 119 publications

References 16 publications

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure

Heart Failure and the Lung

Pulmonary diffusion impairment following heart transplantation: a prospective study

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