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European Heart Journal Advance Access originally published online on October 6, 2006
European Heart Journal 2006 27(21):2538-2543; doi:10.1093/eurheartj/ehl302
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Gas diffusion and alveolar–capillary unit in chronic heart failure

Piergiuseppe Agostoni1,2,*, Maurizio Bussotti1, Gaia Cattadori1, Eliana Margutti3, Mauro Contini1, Manuela Muratori1, Giancarlo Marenzi1 and Cesare Fiorentini1

1 Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, via Parea 4, 20138 Milan, Italy
2 Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA 98185, USA
3 Istituto di Medicina Interna, University of Milan, Milan, Italy

Received 3 May 2006; revised 14 September 2006; accepted 21 September 2006; online publish-ahead-of-print 6 October 2006.

* Corresponding author. Tel: +39 02 58002299; fax: +39 02 58011039. E-mail address: piergiuseppe.agostoni{at}ccfm.it

Aims Alveolar gas diffusion (DLCO) is impaired in chronic heart failure (CHF). Diffusion depends on membrane diffusion (DM) and the amount of blood participating in gas exchange (VC). How DM, VC, and the alveolar–capillary unit behave in relationship to CHF severity is unknown.

Methods and results We measured pulmonary function, including DLCO, DM, VC, and alveolar volume (VA), in 191 CHF patients in NYHA class I–III. CHF patients were grouped accordingly to peak exercise oxygen uptake (pVO2): group <12 mL/min/kg (n=24), group 12–16 (n=76), group 16–20 (n=64), and group >20 (n=27). DLCO, DM, VC, and VA were lowest in severe CHF and were linearly related to pVO2 (DLCO, r=0.577, P<0.001; DM, r=0.490, P<0.001; VC, r=0.216, P<0.01; VA, r=0.565, P<0.01). DM/VC ratio, an index of the alveolar–capillary unit efficiency, was higher in group <12 (0.49±0.39 mL/min/mmHg/mL) and >20 (0.46±0.29), compared with 12–16 (0.34±0.19) and 16–20 (0.35±0.17).

Conclusion DLCO progressively worsens as CHF severity increases due to reduction in lung tissue participating to gas exchange (low VC and VA). In severe CHF, the few working alveolar–capillary units are the most efficient as shown by the high DM/VC. This is useful for maintaining gas exchange efficiency in severe CHF.

Key Words: Heart failure • Exercise • Lung • Oedema • Ventilation


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