The Pulmonary Manifestations of Left Heart Failure

Gehlbach, Brian K.; Geppert, E

doi:10.1378/chest.125.2.669

Cited by 207 publications

(146 citation statements)

References 120 publications

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“…As well as this, a gel-like protein in the thick component of the interstitium serves to absorb this excess fluid, keeping it away from the thinner gas exchange component. 3 Ongoing capillary leak results in pulmonary oedema, of which there are 2 stages. The first, interstitial oedema, results in the engorgement of the perivascular and peribronchial interstitial tissue ("cuffing"), septal thickening and increased lymphatic drainage but has little effect on pulmonary function.…”

Section: Fluid Balance In the Lungmentioning

confidence: 99%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated by its deleterious effects on lung function. HF appears to cause airway obstruction acutely and leads to impaired gas diffusing capacity and pulmonary hypertension in the longer term. It is postulated that this is the result of recurrent episodes of elevated pulmonary capillary pressure leading to pulmonary oedema and pulmonary capillary stress fracture, which produces lung fibrosis. It is likely that impaired lung function impairs the functional status of HF patients and makes them more prone to central sleep apnoea. (Circ J 2010; 74: 2507 - 2516

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Section: Fluid Balance In the Lungmentioning

confidence: 99%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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“…Thus, behavioral plans and motor actions can be initiated following the perceptual process. Furthermore, many patients with different diseases suffer from both aversive symptoms (Gehlbach & Geppert, 2004;Rao & Gray, 2003). Despite many similarities between dyspnea and pain and the high comorbidity of both sensations, our knowledge about interactions regarding their perception is markedly reduced.…”

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confidence: 99%

Experimental comparison of dyspnea and pain

Leupoldt¹,

Dahme²

2007

Behav Res

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“…[8][9][10][11][12] Several factors have been implied to play a role in the etiology of pulmonary function impairment in patients with heart failure, including the effects of heart failure itself on pulmo-nary function in addition to (previously undiagnosed) underlying pulmonary disease and confounding influences, such as smoking, coronary artery bypass grafting, and obesity. [4][5][6][7]13 However, results are not consistent among the studies. For example, although smoking and a history of coronary artery bypass grafting were associated with more impaired pulmonary function in the study of Johnson et al, 13 with also weak associations between left ventricular function and both lung volumes as well as diffusing capacity, none of the described pulmonary function abnormalities were found to be related to either smoking status, use of cardiac drugs, chest radiographic changes, hemodynamic findings, or clinical features, including the duration of heart failure in the study of Wright et al 14 Misdiagnosis of pulmonary function abnormalities may have interfered with the interpretation of prior research aiming to investigate the impact of heart failure and several clinical variables on pulmonary function in this group of patients.…”

Section: Introductionmentioning

confidence: 78%

“…Isolated or combined pulmonary function abnormalities, such as restriction, diffusion impairment, and to a lesser extent airway obstruction are common in patients with chronic heart failure [1][2][3][4][5][6][7] and can contribute to the perception of dyspnea 8 and exercise intolerance. [8][9][10][11][12] Several factors have been implied to play a role in the etiology of pulmonary function impairment in patients with heart failure, including the effects of heart failure itself on pulmo-nary function in addition to (previously undiagnosed) underlying pulmonary disease and confounding influences, such as smoking, coronary artery bypass grafting, and obesity.…”

Section: Introductionmentioning

confidence: 99%

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure

Minasian¹,

Elshout²,

Dekhuijzen

et al. 2015

Respir Care

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BACKGROUND: Using the newer lower limit of normal criterion instead of the conventional cutoff values to define pulmonary function abnormalities may result in different predictors of pulmonary function impairment in patients with heart failure. Therefore, we assessed predictors of pulmonary function impairment in subjects with chronic heart failure according to the lower limit of normal in comparison with conventional cutoff values. METHODS: In this prospective cross-sectional study, 164 chronic heart failure subjects (age 68 ؎ 10 y, 78% men, 88% New York Heart Association class I-II) with left ventricular ejection fraction <40% underwent pulmonary function tests. Predictors of pulmonary function impairment were assessed using the lower limit of normal and conventional cutoff values (ie, 80% predicted value and the fixed ratio of FEV 1 /FVC <0.7). RESULTS: The lower limit of normal criterion identified an extra independent predictor of diffusion impairment compared with the 80% predicted value; in addition to body mass index, pack-years, and alveolar volume, female sex also turned out to be an independent predictor. A smoking history of >10 pack-years was a significant predictor of diffusion impairment and airway obstruction using the lower limit of normal criterion but not using the conventional cutoff values. However, lowering the cutoff points of conventional criteria to match the more stringent lower limit of normal and thus avoid overdiagnosis of diffusion impairment and airway obstruction in the elderly produced similar results as the lower limit of normal. CONCLUSIONS: The lower limit of normal identifies more predictors of diffusion impairment and airway obstruction compared with conventional cutoff values in subjects with chronic heart failure with left ventricular systolic dysfunction. However, lowering the conventional cutoff points yielded similar results as the lower limit of normal. (ClinicalTrials.gov registration NCT01429376.) Key words: Chronic heart failure, conventional cutoff values, lower limit of normal, predictors, pulmonary function impairment. [Respir Care 2016;61(2):173-183.

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The Pulmonary Manifestations of Left Heart Failure

Cited by 207 publications

References 120 publications

Heart Failure and the Lung

Heart Failure and the Lung

Experimental comparison of dyspnea and pain

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure

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