CARDIOVASCULAR MEDICINE

Does lung diffusion impairment affect exercise capacity in patients with heart failure?

P G Agostoni, M Bussotti, P Palermo, M Guazzi

Centro Cardiologico Monzino, IRCCS, Institute of Cardiology, University of Milan, Milan, Italy

Correspondence to:
Correspondence to:
Dr Pier Giuseppe Agostoni, Centro Cardiologico Monzino, Institute of Cardiology, University of Milan, via Parea 4, 20138 Milan, Italy;
piergiuseppe.agostoni{at}cardiologicomonzino.it

Objective: To determine whether there is a relation between impairment of lung diffusion and reduced exercise capacity in chronic heart failure.

Design: 40 patients with heart failure in stable clinical condition and 40 controls participated in the study. All subjects underwent standard pulmonary function tests plus measurements of resting lung diffusion (carbon monoxide transfer, TLCO), pulmonary capillary volume (VC), and membrane resistance (DM), and maximal cardiopulmonary exercise testing. In 20 patients and controls, the following investigations were also done: (1) resting and constant work rate TLCO; (2) maximal cardiopulmonary exercise testing with inspiratory O₂ fractions of 0.21 and 0.16; and (3) rest and peak exercise blood gases. The other subjects underwent TLCO, DM, and VC measurements during constant work rate exercise.

Results: In normoxia, exercise induced reductions of haemoglobin O₂ saturation never occurred. With hypoxia, peak exercise uptake (peak O₂) decreased from (mean (SD)) 1285 (395) to 1081 (396) ml/min (p < 0.01) in patients, and from 1861 (563) to 1771 (457) ml/min (p < 0.05) in controls. Resting TLCO correlated with peak O₂ in heart failure (normoxia < hypoxia). In heart failure patients and normal subjects, TLCO and peak O₂ correlated with O₂ arterial content at rest and during peak exercise in both normoxia and hypoxia. TLCO, VC, and DM increased during exercise. The increase in TLCO was greater in patients who had a smaller reduction of exercise capacity with hypoxia. Alveolar–arterial O₂ gradient at peak correlated with exercise capacity in heart failure during normoxia and, to a greater extent, during hypoxia.

Conclusions: Lung diffusion impairment is related to exercise capacity in heart failure.

Keywords: heart failure; exercise; lung function

Abbreviations: CaO₂, arterial oxygen content; DM; membrane resistance; P[A-aO₂], alveolar; arterial oxygen pressure gradient; FEV₁, forced expiratory volume in one second; FiO₂, inspired oxygen fraction; FVC, forced vital capacity; MVV, maximum voluntary ventilation; PaO₂, systemic arterial oxygen tension; SaO₂, haemoglobin saturation with oxygen; TLCO, carbon monoxide transfer; VC, pulmonary capillary blood volume; O₂; oxygen uptake

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