Copyright © 1995 by the European Society of Cardiology.
© 1995 The European Society of Cardiology
Exercise intolerance in patients with chronic heart failure: role of pulmonary diffusing limitation
Services de Cardiologie, Hópital Arnaud de Villeneuve 34 Montpellier, France
*Laboratoire Central d'Explorations Fonctionnelles Respiratoires, Hópital Arnaud de Villeneuve 34 Montpellier, France
Received 28 February 1994; revised 25 July 1994; accepted 10 August 1994.
Correspondence: Dr Messner-Pellenc, Services de Cardiologie, Hopital Arnaud dc Villeneuve, CHU Montpellier, 34295 Montpellter Cedex 5, France.
Abstract
In order to test the hypothesis of pulmonary diffusing capacity involvement in exercise limitation in subjects with chronic heart failure (CHF), lung transfer factor (TLCO), oxygen saturation (SaO2), cardiac output (CO) and gas exchange were studied over the course of an incremental exercise test in 10 patients and 10 controls. Tlie TLCO and transfer coefficient for carbon monoxide (TLCOIVA) were measured at rest and during recovery by the single breath method. Tlie SaO2 was followed non-invasively with a finger oximeter and CO was determined according to the carbon dioxide rebreathing method. Analysis of respiratory variables at maximal effort showed significantly lower values in patients with CHF as regards peak oxygen uptake (VO2), minute ventilation (VE), heart rate (HR), oxygen pulse (O2 pulse), and CO with higher ventilatory reserve (VR) than controls. At a comparable workload (30 W), patients with CHF demonstrated higher values for VE and lower values for CO than controls. The TLCO, expressed as percent of predicted values, was significantly lower in CHF patients than controls, respectively, at rest (90.5 ±3.75% vs 106.8 ±3.8%) and within 5 min after maximal exercise (87 ±4.4% vs 117.4 +3.81%). Hie TLCOIVA showed comparable data between the two groups at rest (81.7 ± 3.28 vs 90.3 ± 2.86%). However, significantly lower values of TLCOIVA were obtained for CHF after maximal exercise in comparison to control subjects (77.5 ±3.85% vs 96.3 ±3.95%).
These results confirm the alteration of the main variables in relation to cardiopulmonary exercise limitation in CHF, and indicate a significant decrease in TLCO and TLCOIVA after maximal exercise. Due to a possible accumulation of interstitial fluid, there is a suggestion of pulmonary suboedema involvement during exercise in these patients.
Key Words: Pulmonary diffusing capacity • chronic heart failure • cardiopulmonary exercise testing
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