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European Heart Journal Advance Access published online on October 6, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl302
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received May 3, 2006
Revised September 14, 2006
Accepted September 21, 2006

Clinical research

Gas diffusion and alveolar-capillary unit in chronic heart failure

Piergiuseppe Agostoni 1 *, Maurizio Bussotti 2, Gaia Cattadori 2, Eliana Margutti 3, Mauro Contini 2, Manuela Muratori 2, Giancarlo Marenzi 2, and Cesare Fiorentini 2

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

* To whom correspondence should be addressed.
Piergiuseppe Agostoni, E-mail: piergiuseppe.agostoni{at}ccfm.it


  Abstract

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.

Keywords: Heart failure; Exercise; Lung; Oedema; Ventilation.
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