Chest
Volume 98, Issue 4, October 1990, Pages 816-820
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Ventilatory and Diffusion Abnormalities in Potential Heart Transplant Recipients

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Few data are available concerning pulmonary function in patients with severe chronic congestive heart failure. Of 315 patients evaluated for potential cardiac transplantation at UCLA, 132 underwent pulmonary function tests. The latter patients had severe heart failure with a mean left ventricular ejection fraction of 19 percent and mean cardiac index of 2.1 L/min/m2. Diffusion impairment either alone or combined with restrictive and/or obstructive ventilatory defects occured in 67 percent of the patients evaluated. Diffusion impairment occurred as the sole abnormality in 31 percent of the patients and in combination with a restrictive ventilatory defect in 21 percent. A reduction in diffusing capacity has not been previously described as a frequent finding in patients with chronic congestive heart failure. In contrast to other studies involving patients with acute heart failure, obstructive ventilatory defects were uncommon. None of the lung function abnormalities was associated with smoking status, prior drug use, chest roentgenographic changes, hemodynamic findings, or clinical features, including duration of congestive heart failure. The mechanism for the diffusion impairment is unclear but could be due to chronic passive congestion with pulmonary fibrosis and/or recurrent pulmonary emboli. Recognition of diffusion impairment as a common finding in patients with severe chronic congestive heart failure who are candidates for heart transplantation is important for proper interpretation of possible post-transplant changes in diffusing capacity due to other causes.

Section snippets

MATERIALS AND METHODS

Three hundred and fifteen patients were evaluated at UCLA Medical Center for potential cardiac transplantation. Criteria for consideration for possible heart transplantation included either intractable congestive heart failure which markedly impaired the quality of life or a very high likelihood of sudden cardiac death within the next year, in the absence of other reasonable surgical options.6 Of this group, 132 patients (105 men and 27 women, mean age 51 years) underwent pulmonary function

RESULTS

Subject characteristics are shown in Table 1. The majority of the patients were middle-aged men who were either former or current smokers. Although a few patients presented with congestive heart failure of only brief duration, most patients had either class 3 or 4 disease according to the New York Heart Association Classification. The etiology of heart disease was coronary artery disease in 54 percent, idiopathic in 21 percent, valvular heart disease in 8 percent, viral cardiomyopathy in 5

DISCUSSION

Diffusion impairment either alone or combined with ventilatory restriction and/or obstruction was found in 67 percent of patients with severe congestive heart failure who underwent pulmonary function testing as part of an evaluation for possible heart transplantation. Isolated diffusion impairment was the single most common abnormality, occurring in 31 percent of these patients. Because significant restriction was not present in the latter patients, the diffusion impairment could not be

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      Citation Excerpt :

      This was also true for patients in a stable clinical condition who did not have signs of pulmonary congestion. Prevalence rates of diffusion impairment and airway obstruction were 41–93%13–19 and 14–60%,13–18,20,21 respectively, in prior studies that have often included heart transplant recipients. Our results extend these studies by demonstrating that these abnormalities are also highly prevalent in patients with less severe heart failure who were mainly in NYHA class II.

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    Presented in part at the annual meeting, American Thoracic Society, Cincinnati, May 15, 1989.

    Manuscript received January 10; revision accepted March 13.

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