Lung function and exercise gas exchange in chronic heart failure

Karlman Wasserman, Yong Yu Zhang, Anselm Gilt, Romualdo Belardinelli, Akira Koike, Laura Lubarsky, Pier G. Agostoni

Research output: Contribution to journalArticle

Abstract

Background: The ventilatory response to exercise in patients with chronic heart failure (HF) is greater than normal for a given metabolic rate. The objective of the present study was to determine the mechanism(s) for the high ventilatory output in patients with chronic HF. Methods and Results: Centers in Germany, Italy, Japan, and the United States participated in this study. Each center contributed studies on patients and normal subjects of similar age and sex. One hundred thirty patients with chronic HF and 52 healthy subjects participated. Spirometric and breath-by-breath gas exchange measurements were made during rest and increasing cycle exercise. Arterial blood was sampled for measurement of pH, Paco2, Pao2, and lactate during exercise in 85 patients. Resting forced expiratory volume in 1 second (FEV1) and vital capacity (VC) were proportionately reduced at all levels of impairment. Patients with more severe HF had greater tachypnea and a smaller tidal volume (VT) at a given exercise expired volume per unit time (VE). This was associated with an expiratory flow pattern characteristic of lung restriction. VE and VCO2 as a function of VO2 were increased during exercise in. HF patients. The increases were greater the lower the peak VO2 per kilogram of body weight. The ratio of VD (physiological dead space) to VT and the difference between arterial and end tidal PCO2 at peak VO2 also increased inversely with peak VO2kg. In contrast, the difference between alveolar and arterial PO2 and PaCO2 were both normal, on average, at peak VO2 regardless of the level of impairment. The more severe the exercise limitation, the higher the lactate and the lower the HCO3 - at a given VO2, although pH was tightly regulated. Conclusions: The increase in ̇E in chronic HF patients is caused by an increase in VD/VT due to high ventilation/perfusion mismatching, an increase in ̇CO2 relative to VO2 resulting from HCO3 - buffering of lactic acid, and a decrease in PaCO2 due to tight regulation of arterial pH. With regard to the excessive ̇E in HF patients, the increases in VD/VT and VCO2 relative to ̇O2 are more important as the patient becomes more exercise limited. Regional hypoperfusion but not hypoventilation typifies lung gas exchange in HF. This and other mechanisms might account for the restrictive changes leading to exercise tachypnea in HF patients.

Original languageEnglish
Pages (from-to)2221-2227
Number of pages7
JournalCirculation
Volume96
Issue number7
Publication statusPublished - Oct 7 1997

Keywords

  • Hypertension
  • Metabolism
  • Oxygen
  • Perfusion
  • Pulmonary
  • Ventilation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Wasserman, K., Zhang, Y. Y., Gilt, A., Belardinelli, R., Koike, A., Lubarsky, L., & Agostoni, P. G. (1997). Lung function and exercise gas exchange in chronic heart failure. Circulation, 96(7), 2221-2227.