Impact of chronic systolic heart failure on lung structure-function relationships in large airways

Chase, Steven C.; Wheatley, Courtney M.; Olson, Lyle J.; Beck, Kenneth C.; Wentz, Robert J.; Snyder, Eric M.; Taylor, Bryan J.; Johnson, Bruce D.

doi:10.14814/phy2.12867

Cited by 9 publications

(6 citation statements)

References 36 publications

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“…One study in dogs using CT scanning found approximately a 20% reduction in airway area with saline infusion [32]. A previous study in our lab found small reductions in the luminal airway of the large airways after fluid loading, but no differences in large airways in patients with HF [15, 33]. These divergent findings confound the understanding of the relationship between pulmonary function and thoracic blood volumes that were found in this study.…”

Section: Discussioncontrasting

confidence: 52%

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Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure

Chase

Taylor

Cross

et al. 2017

Journal of Cardiac Failure

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Introduction Pulmonary congestion is a common finding of heart failure (HF), but it remains unclear how pulmonary and heart blood volumes (Vp and Vh) and extravascular lung water (EVLW) change in stable HF and impact lung function. Methods Fourteen patients with HF (age: 68±11 y; LVEF: 33±8%) and 12 controls (age: 65±9 y) were recruited. A pulmonary function test, thoracic CT scan, and contrast perfusion scan were performed. From the thoracic scan, a histogram of CT attenuation of lung tissue was generated and skew, kurtosis, and full-width half-max were calculated as surrogates of EVLW. Blood volumes were calculated from the transit time of the contrast through the great vessels of the heart. Results Patients with HF had greater Vp and Vh (Vp: 0.55±0.21 l v.s 0.41±0.13 l; Vh: 0.53±0.33 l vs. 0.40±0.15 l) and EVLW (skew: 3.2±0.5 vs. 3.7±0.7; kurtosis: 19.4±6.6 vs. 25.9±9.4; FWHM: 73±13 vs 59±9Hu). Spirometric measures were decreased in HF (%-predicted FVC: 86±17% vs. 104±9%; FEV1: 83±20% vs. 105±11%; FEF25–75: 82±42% vs. 115±43%). Vp was associated with decreased expiratory flows, while EVLW was associated with decreased lung volumes. Conclusions Congestion in stable patients with HF includes expanded Vp and increased EVLW associated with reductions in lung volumes and expiratory flows.

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Section: Discussioncontrasting

confidence: 52%

“…A histogram technique to semi-quantitatively measure differences in EVLW was used [23, 33, 36]. A decreased skew and kurtosis and increased FWHM as found here suggest the presence of additional EVLW in stable, chronic patients with HF compared with control subjects.…”

Section: Discussionmentioning

confidence: 85%

Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure

Chase

Taylor

Cross

et al. 2017

Journal of Cardiac Failure

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“…12,14 Following treatment, spirometric measures were greatly improved but remained lower than those of chronic, stable patients observed in our laboratory. 8,14 Additionally, DLCO and Vc did not change, but Dm and Dm/Vc ratio improved. These changes were paralleled by clearance of EVLW, suggesting the pulmonary congestion present at admission was at least partially cleared by hospital discharge.…”

Section: Discussionmentioning

confidence: 94%

“…We have previously demonstrated increased levels of extravascular lung water (EVLW) associated with decreased pulmonary function in chronic, stable HF patients. 8 In these patients, there is decreased pulmonary function, including forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), and forced expiratory flow at 25-75% of FVC (FEF ); decreased diffusing capacity for carbon monoxide (DLCO); and altered gas exchange at both rest and exercise. [9][10][11] However, the degree to which these functional variables may be modified by therapeutic intervention during an acute decompensation and recovery during a course of inpatient treatment has not been well characterized.…”

Section: Introductionmentioning

confidence: 99%

The effect of diuresis on extravascular lung water and pulmonary function in acute decompensated heart failure

et al. 2018

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AimsThe effect of extravascular lung water (EVLW) and relationship to functional status as a result of acute decompensated heart failure (ADHF) are not well understood. We sought to quantify changes in clinical variables, EVLW, airway anatomy, spirometry, and diffusing capacity for carbon monoxide before and after treatment for ADHF.Methods and resultsFifteen patients were recruited within 24 h of hospital admission. Spirometry, diffusing capacity for carbon monoxide, and surrogates of EVLW by computed tomography were measured and were then repeated within 24 h of discharge. From the computed tomography (CT) scan, surrogates of EVLW were calculated from the distribution of CT attenuation of the lung tissue. Airways were segmented using the vida apollo software. Patients were hospitalized for 4.6 ± 2.1 days, had 10 ± 4.8 L of fluid removed (7.0 ± 4.2 L between study visits), and lost 7.1 ± 4.9 kg. Patients had significant clearance of fluid from the lungs (per cent change: mean, 4.2 ± 6.1%; skew, 17.5 ± 27.0%; kurtosis, 37.6 ± 56.7%; full‐width half‐maximum, 10.2 ± 13.5%). Static lung volumes and maximal flows improved significantly (per cent change: forced vital capacity, 14.5 ± 13.6%; forced expiratory volume in 1 s, 15.9 ± 14.0%; forced expiratory flow at 25–75% of forced vital capacity, 27.2 ± 42.9%). The ratio of membrane conductance to capillary blood volume improved significantly (per cent change: alveolar–capillary membrane conductance/capillary blood volume, 23.4 ± 22.8%). Weight loss during hospitalization was significantly correlated with improved spirometry and diffusing capacity.ConclusionsExtravascular lung water contributes to the pulmonary congestive syndrome in ADHF patients, and its clearance is an important component of the improvement in pulmonary function as a result of inpatient treatment.

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“…Recently, we have reported that CT derived measures of large airway wall thickness and luminal area are not different in healthy control subjects relative to stable HFrEF patients (27). In combination with the findings of the present study, data from our laboratory suggest that stable, well compensated HFrEF patients have evidence of elevated lung fluid volume but not substantial large airway edema and/or engorgement relative to their healthy age and sex matched counterparts.…”

Section: Discussionmentioning

confidence: 99%

Effect of β 2 -adrenergic receptor stimulation on lung fluid in stable heart failure patients

Taylor

Snyder

Richert

et al. 2017

The Journal of Heart and Lung Transplantation

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Introduction The purpose of this study was to determine 1) if stable heart-failure patients with reduced ejection fraction (HFrEF) have elevated extravascular lung water (EVLW) versus healthy control subjects, and 2) the effect of acute β2AR agonist inhalation on lung fluid balance. Methods Twenty-two stable HFrEF patients and 18 age- and sex-matched healthy subjects were studied. Lung diffusing capacity for carbon monoxide (DLCO), alveolar-capillary conductance (DmCO), pulmonary capillary blood volume (Vc) (via rebreathe) and lung tissue volume (Vtis) (via computed tomography) were assessed before and within 30 min of administration of nebulized albuterol. EVLW was derived as Vtis – Vc. Results Pre-albuterol, Vtis and EVLW were greater in HFrEF vs. control (998 ± 200 vs. 884 ± 123 ml, P = 0.041; 943 ± 202 vs. 802 ± 133 ml, P = 0.015, respectively). Albuterol decreased Vtis and EVLW in HFrEF (−4.6 ± 7.8%, P = 0.010; −4.6 ± 8.8%, P = 0.018) and control (−2.8 ± 4.9%, P = 0.029; −3.0 ± 5.7%, P = 0.045). There was an inverse relationship between pre-albuterol values and the pre- to post-albuterol change for EVLW (r2 = −0.264, P = 0.015) and DmCO (r2 = −0.343, P = 0.004) in HFrEF only. Conclusion Lung fluid is elevated in stable HFrEF patients relative to healthy subjects. Stimulation of the β2ARs may cause fluid removal in HFrEF, especially in patients who exhibit greater evidence for increased lung water at baseline.

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Impact of chronic systolic heart failure on lung structure-function relationships in large airways

Cited by 9 publications

References 36 publications

Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure

Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure

The effect of diuresis on extravascular lung water and pulmonary function in acute decompensated heart failure

Effect of β 2 -adrenergic receptor stimulation on lung fluid in stable heart failure patients

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