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Reduction in membrane component of diffusing capacity is associated with the extent of acute pulmonary embolism

Päivi Piirilä1, Mia Laiho, Pirjo Mustonen

  • 1Department of Clinical Physiology, HUSLAB, Helsinki University Central Hospital, Finland. paivi.piirila@hus.fi

Clinical Physiology and Functional Imaging
|December 15, 2010
PubMed

Insights

Acute pulmonary embolism (PE) significantly reduces diffusing capacity of the alveolo-capillary membrane (DM) and pulmonary diffusing capacity for carbon monoxide (DL,CO). These reductions persist long-term, primarily due to DM impairment, even after treatment.

Area of Science:

  • Pulmonary Medicine
  • Cardiopulmonary Physiology

Background:

  • Acute pulmonary embolism (PE) is known to impair pulmonary diffusing capacity for carbon monoxide (DL,CO).
  • The precise mechanisms and long-term consequences of this impairment, particularly concerning the diffusing capacity of the alveolo-capillary membrane (DM) and pulmonary capillary blood volume (Vc), remain incompletely understood.

Purpose of the Study:

  • To investigate the association between the extent of PE, right ventricular dysfunction (RVD), and reductions in DM and Vc.
  • To assess the recovery of these parameters 7 months after acute PE.

Main Methods:

  • Spiral computed tomography (CT) to assess PE extent.
  • Single-breath method using carbon monoxide and oxygen to measure DL,CO, Vc, DM, and alveolar volume (VA).
  • Transthoracic echocardiography and electrocardiogram for RVD evaluation.

Main Results:

  • Patients with acute PE exhibited significantly lower DL,CO, DM, and vital capacity (VC) compared to healthy controls.
  • DM showed an inverse correlation with the central mass of embolism.
  • Despite significant improvements within 7 months, DM and DL,CO remained lower than in controls, especially in patients with persistent RVD.

Conclusions:

  • Reduction in DM is the primary driver of sustained DL,CO decrease in PE patients after 7 months.
  • The extent of PE and RVD severity influence the impairment of DM and DL,CO.
  • Long-term follow-up reveals persistent deficits in diffusing capacity despite treatment.

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