Copyright © 2002 by the European Society of Cardiology.
Alveolar–capillary membrane gas conductance: a novel prognostic indicator in chronic heart failure
a Centro Cardiologico, I.R.C.C.S., Centro di Studio Ricerche Cardiovascolari del Consiglio Nazionale delle Ricerche, Istituto di Cardiologia dell’Università, Milan, Italy
b Istituto di Statistica Medica e Biometria dell’Università, Milan, Italy
revised May 25, 2001; accepted June 1, 2001
Abstract
Aims Lung dysfunction occurring in chronic heart failure worsens clinical status and exercise performance. The prognostic value of airway and alveolar function measurements in chronic heart failure has not been explored. We aimed to evaluate the prognostic value of lung function tests in a population of patients with stable chronic heart failure.
Methods and Results One hundred and six stable chronic heart failure patients (whose left ventricular ejection fraction averaged 33±1%) underwent echocardiography, metabolic stress testing, assessment of pulmonary function at rest (by spirometry), of alveolar diffusing capacity (DLco) (with carbon monoxide technique) and of its membrane (DM) and capillary blood volume (Vc) components. Prognostic relevance of pulmonary variables was assessed by the Kaplan–Meier approach with log-rank testing and by Cox regression analysis. Cut-off values of lung parameters were based on the 33rd and 66th centiles. Seventeen patients died for cardiac reasons. Non-survivors compared to survivors showed lower forced expiratory volume in 1s (2·1±0·1 vs 2·4±0·1l;P <0·01), forced vital capacity (2·6±0·1 vs 2·9±0·1l;P <0·01), maximal voluntary ventilation (80·7±2·5vs 95·4±2·7l; P<0·01), DLco (16·5±1·1 vs 19·3±0·6ml.min–1.mmHg–1;P <0·01) and DM (25·1±1·8 vs 31·9±1·5ml.min–1.mmHg–1;P <0·01). They also exhibited a smaller peak VO2 (14·6±0·7 vs 15·9±0·6ml.min–1.kg–1;P <0·05) and a steeper VE/VCO2 slope (45·0±1·7 vs 41·9±1·5;P <0·01). Multivariate analysis revealed that DM was the only independent predictor of cardiac death. Cases at high risk for adverse outcome were identified by a DM<24·7ml.min–1.mmHg–1. Patients receiving ACE-inhibitors presented with a higher DM (32·1±1·7 vs 27·9±1·7ml.min–1.mmHg–1,P <0·05) as well as a better Cox estimated survival rate.
Conclusions Impaired DM is a powerful independent predictor of worse prognosis in stable chronic heart failure and may be considered an additional index of disease severity, as well as a specific therapeutic target.
Key Words: Heart failure, pulmonary function, survival
f1 Correspondence: Marco Guazzi, MD, PhD, FACC, Istituto di Cardiologia dell'Università, Centro Cardiologico, Via Parea, 4, 20138 Milano, Italy.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. Agostoni, M. Bussotti, G. Cattadori, E. Margutti, M. Contini, M. Muratori, G. Marenzi, and C. Fiorentini Gas diffusion and alveolar-capillary unit in chronic heart failure Eur. Heart J., November 1, 2006; 27(21): 2538 - 2543. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Palermo, G. Cattadori, M. Bussotti, A. Apostolo, M. Contini, and P. Agostoni Lateral Decubitus Position Generates Discomfort and Worsens Lung Function in Chronic Heart Failure Chest, September 1, 2005; 128(3): 1511 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Ravipati, W. S. Aronow, J. Sidana, G. P. Maguire, J. A. McClung, R. N. Belkin, and S. G. Lehrman Association of Reduced Carbon Monoxide Diffusing Capacity With Moderate or Severe Left Ventricular Diastolic Dysfunction in Obese Persons Chest, September 1, 2005; 128(3): 1620 - 1622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Agostoni, A. Magini, D. Andreini, M. Contini, A. Apostolo, M. Bussotti, G. Cattadori, and P. Palermo Spironolactone improves lung diffusion in chronic heart failure Eur. Heart J., January 2, 2005; 26(2): 159 - 164. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bonay, C. Bancal, D. de Zuttere, F. Arnoult, G. Saumon, and F. Camus Normal Pulmonary Capillary Blood Volume in Patients With Chronic Infiltrative Lung Disease and High Pulmonary Artery Pressure Chest, November 1, 2004; 126(5): 1460 - 1466. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Guazzi, G. Reina, G. Tumminello, and M. D. Guazzi Improvement of alveolar-capillary membrane diffusing capacity with exercise training in chronic heart failure J Appl Physiol, November 1, 2004; 97(5): 1866 - 1873. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Agostoni, G. Cattadori, M. Bianchi, and K. Wasserman Exercise-Induced Pulmonary Edema in Heart Failure Circulation, November 25, 2003; 108(21): 2666 - 2671. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Guazzi Alveolar-Capillary Membrane Dysfunction in Heart Failure: Evidence of a Pathophysiologic Role Chest, September 1, 2003; 124(3): 1090 - 1102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Guazzi, R. Brambilla, G. Reina, G. Tumminello, and M. D. Guazzi Aspirin-Angiotensin-Converting Enzyme Inhibitor Coadministration and Mortality in Patients With Heart Failure: A Dose-Related Adverse Effect of Aspirin Arch Intern Med, July 14, 2003; 163(13): 1574 - 1579. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Guazzi, R. Brambilla, S. De Vita, and M. D. Guazzi Diabetes Worsens Pulmonary Diffusion in Heart Failure, and Insulin Counteracts This Effect Am. J. Respir. Crit. Care Med., October 1, 2002; 166(7): 978 - 982. [Abstract] [Full Text]
|
|
|
|
|
|
M. Schaufelberger Pulmonary diffusion capacity as prognostic marker in chronic heart failure Eur. Heart J., March 2, 2002; 23(6): 429 - 431. [Full Text] [PDF]
|
|