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Lung function and exercise gas exchange in chronic heart failure

K Wasserman1, Y Y Zhang, A Gitt

  • 1Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, Calif 90509, USA.

Circulation
|October 23, 1997
PubMed
Summary

Patients with chronic heart failure (HF) exhibit increased ventilation during exercise due to ventilation/perfusion mismatching and buffering of lactic acid. These factors, along with reduced physiological dead space to tidal volume ratio, contribute to exercise limitation in HF.

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Area of Science:

  • Cardiopulmonary exercise physiology
  • Respiratory medicine
  • Heart failure research

Background:

  • Patients with chronic heart failure (HF) show a greater ventilatory response to exercise than normal for a given metabolic rate.
  • The mechanisms driving this heightened ventilatory output in chronic HF patients require elucidation.

Purpose of the Study:

  • To determine the underlying physiological mechanisms responsible for the increased ventilatory response during exercise in patients with chronic heart failure.

Main Methods:

  • Multi-center study involving 130 chronic HF patients and 52 healthy subjects.
  • Spirometry and breath-by-breath gas exchange measurements during rest and incremental cycle exercise.
  • Arterial blood gas analysis (pH, PaCO2, PaO2, lactate) in a subset of patients.

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Main Results:

  • Chronic HF patients displayed increased ventilation (VE) and carbon dioxide production (VCO2) relative to oxygen consumption (VO2) during exercise.
  • Higher severity of HF correlated with greater tachypnea, reduced tidal volume, and increased physiological dead space to tidal volume ratio (VD/VT).
  • Lactate levels and bicarbonate (HCO3-) decreased, while arterial PCO2 (PaCO2) was tightly regulated, indicating buffering of lactic acid.

Conclusions:

  • Increased VE in chronic HF is driven by ventilation/perfusion (V/Q) mismatching (increased VD/VT) and buffering of lactic acid (increased VCO2/VO2).
  • The contribution of V/Q mismatching and lactic acid buffering to excessive ventilation intensifies with greater exercise limitation in HF.
  • Lung gas exchange in HF is characterized by regional hypoperfusion and restrictive lung changes, contributing to exercise tachypnea.