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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Impaired Pulmonary Diffusion in Heart Failure With Preserved Ejection Fraction
Thomas P Olson1, Bruce D Johnson1, Barry A Borlaug1
1Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Minnesota.
JACC. Heart Failure
|June 4, 2016
Summary
Patients with heart failure with preserved ejection fraction (HFpEF) show impaired lung diffusion and gas exchange, contributing to exercise intolerance. Therapies targeting gas diffusion could improve exercise capacity in HFpEF patients.
Area of Science:
- Pulmonary physiology
- Cardiopulmonary exercise testing
- Heart failure research
Background:
- Heart failure with preserved ejection fraction (HFpEF) is associated with elevated left heart pressures.
- The impact of these pressures on pulmonary gas transfer and its determinants during rest and exercise remains unclear.
Purpose of the Study:
- To compare gas exchange measurements at rest and during exercise in patients with HFpEF versus healthy controls.
- To investigate the determinants of pulmonary gas transfer in HFpEF.
Main Methods:
- 20 patients with HFpEF and 26 controls underwent recumbent cycle ergometry with simultaneous gas exchange and ventilation measurement.
- Lung diffusion for carbon monoxide (DLCO) and its components (pulmonary capillary blood volume [VC] and alveolar-capillary membrane conductance [DM]) were measured at rest and during exercise.
- Stroke volume and cardiac output were assessed using echocardiography.
Main Results:
- HFpEF patients exhibited impaired diastolic function and reduced exercise capacity.
- At rest, HFpEF patients had significantly lower DLCO (24% reduction) due to decreased DM and VC.
- During exercise, DLCO remained lower in HFpEF patients, with notable reductions in DM and a plateau in VC, contributing to a 30% lower DLCO at peak exercise.
Conclusions:
- HFpEF is characterized by altered pulmonary function and gas exchange, exacerbating exercise intolerance.
- Novel therapeutic strategies aimed at enhancing gas diffusion show potential for improving exercise tolerance in HFpEF.
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