Cardiovascular medicine
The alveolar-capillary membrane diffusing capacity and the
pulmonary capillary blood volume in heart transplant candidates
O A Al-Rawasa, R Cartera, R D Stevensona, S K Naikb, D J Wheatleyb
a Department of
Respiratory Medicine, Glasgow Royal Infirmary, Glasgow G31 2ES,
UK, b University Department of Cardiac Surgery,
Glasgow Royal Infirmary
Correspondence to: Dr O A Al-Rawas, Department of Medicine, College of Medicine, Sultan Qaboos University, PO Box 35, Postal Code 123, Muscat, Sultanate of Oman email: orawas{at}squ.edu.om
Accepted 23 August
1999
OBJECTIVES
To determine the mechanism of impairment of
pulmonary transfer factor for carbon monoxide (TLCO) in
heart transplant candidates, as this is the most common lung function abnormality.
SETTINGRegional cardiopulmonary transplant centre.
METHODSTLCO and its components (the
diffusing capacity of the alveolar-capillary membrane (DM)
and the pulmonary capillary blood volume (VC)) were
measured using the Roughton and Forster method and the single breath
technique in 38 patients with severe chronic heart failure awaiting
heart transplantation (mean age 51 years, range 19 to 61; mean left
ventricular ejection fraction 12.8%). Results were compared with data
from 26 normal subjects (mean age 47 years, range 27 to 62).
RESULTSMean per cent predicted TLCO,
DM, and VC were significantly reduced in
patients (69.9%, 81.4%, and 80.2% of predicted, respectively) compared with controls (97.7%, 100.1%, and 102.3% of predicted, respectively, p < 0.001). The relative contribution of the two components of TLCO in patients was similar to that of
normal subjects, with each component accounting for approximately 50%
of the total resistance to diffusion (1/TLCO).
CONCLUSIONSTLCO impairment in patients with
severe chronic heart failure awaiting heart transplantation results
from a proportionate reduction in both DM and
VC, suggesting a significant disturbance of the pulmonary
vascular bed.
Keywords: heart failure; diffusing capacity; pulmonary transfer factor; pulmonary capillary blood volume
© 2000 by Heart
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