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Risom EC, Buggeskov KB, Petersen RH, Mortensen J, Ravn HB. Influence of reduced diffusing capacity and FEV 1 on outcome after cardiac surgery. Acta Anaesthesiol Scand 2021; 65:1221-1228. [PMID: 34089538 DOI: 10.1111/aas.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Impaired lung function is a well-known risk factor in cardiac surgery patients and reduced forced expiratory volume in 1 second (FEV1 ) is associated with increased mortality. However, there is limited knowledge regarding the influence of impaired diffusing capacity of the lungs for carbon monoxide (DLCO) in unselected cardiac surgery patients. The aim of this study was to investigate the association of impaired DLCO and/or reduced FEV1 on post-operative mortality and morbidity in cardiac surgery patients. METHODS In a prospective cohort study, 390 patients scheduled for elective cardiac surgery underwent preoperative lung function test including spirometry and DLCO measurements. We defined reduced FEV1 as FEV1 below lower limit of normal (LLN) and impaired DLCO as DLCO <60% of predicted. RESULTS Mortality within 1 year (90-570 days) was significantly higher in patients with impaired DLCO (12% vs 3%, P = .010) and with reduced FEV1 (9% vs 3%, P = .028). Mortality was higher in patients with impaired DLCO both in the presence and absence of FEV1 < LLN. In multivariate analysis, only impaired DLCO [OR: 3.3, 95% confidence interval (CI) 1.4-7.5; P = .005] and age (OR: 1.1 per year, 95% CI 1.0-1.2; P = .001) were independent predictors of the combined outcome of mortality and prolonged intensive care unit (ICU) stay. Impaired DLCO was also associated with post-operative respiratory complications. CONCLUSION In patients undergoing elective cardiac surgery, preoperative impaired FEV1 and DLCO were associated with increased mortality and morbidity. In multivariate analysis, only DLCO and age were independent predictors of a combined outcome of mortality and prolonged ICU stay.
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Affiliation(s)
- Emilie C. Risom
- Department of Cardiothoracic Anaesthesiology Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Katrine B. Buggeskov
- Department of Cardiothoracic Anaesthesiology Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - René H. Petersen
- Department of Cardiothoracic Surgery Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Jann Mortensen
- Department of Clinical Physiology Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Hanne B. Ravn
- Department of Cardiothoracic Anaesthesiology Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
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Heidorn MW, Steck S, Müller F, Tröbs SO, Buch G, Schulz A, Schwuchow-Thonke S, Schuch A, Strauch K, Schmidtmann I, Lackner KJ, Gori T, Münzel T, Wild PS, Prochaska JH. FEV 1 Predicts Cardiac Status and Outcome in Chronic Heart Failure. Chest 2021; 161:179-189. [PMID: 34416218 DOI: 10.1016/j.chest.2021.07.2176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COPD is an established predictor of clinical outcome in patients with chronic heart failure (HF). However, little evidence is available about the predictive value of FEV1 in chronic HF. RESEARCH QUESTION Is pulmonary function related to the progression of chronic HF? STUDY DESIGN AND METHODS The MyoVasc study (ClinicalTrials.gov Identifier: NCT04064450) is a prospective cohort study of HF. Information on pulmonary and cardiac functional and structural status was obtained by body plethysmography and echocardiography. The primary study end point was worsening of HF. RESULTS Overall 2,998 participants (age range, 35-84 years) with available FEV1 data were eligible for analysis. Linear multivariate regression analysis revealed an independent relationship of FEV1 (per -1 SD) with deteriorated systolic and diastolic left ventricle (LV) function as well as LV hypertrophy under adjustment of age, sex, height, cardiovascular risk factors (CVRFs), and clinical profile (LV ejection fraction: β-estimate, -1.63% [95% CI, -2.00% to -1.26%]; E/E' ratio: β-estimate, 0.82 [95% CI, 0.64-0.99]; and LV mass/height2.7: β-estimate, 1.58 [95% CI, 1.07-2.10]; P < .001 for all). During a median time to follow-up of 2.6 years (interquartile range, 1.1-4.1 years), worsening of HF occurred in 235 individuals. In Cox regression model adjusted for age, sex, height, CVRF, and clinical profile, pulmonary function (FEV1 per -1 SD) was an independent predictor of worsening of HF (hazard ratio [HR], 1.44 [95% CI, 1.27-1.63]; P < .001). Additional adjustment for obstructive airway pattern and C-reactive protein mitigated, but did not substantially alter, the results underlining the robustness of the observed effect (HRFEV1, 1.39 [95% CI, 1.20-1.61]; P < .001). The predictive value of FEV1 was consistent across subgroups, including individuals without obstruction (HR, 1.55 [95% CI, 1.34-1.77]; P < .001) and nonsmokers (HR, 1.72 [95% CI, 1.39-1.96]; P < .001). INTERPRETATION FEV1 represents a strong candidate to improve future risk stratification and prevention strategies in individuals with chronic, stable HF. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT04064450; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Marc W Heidorn
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Stefanie Steck
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Felix Müller
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Sven-Oliver Tröbs
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Gregor Buch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sören Schwuchow-Thonke
- German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander Schuch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Konstantin Strauch
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tommaso Gori
- German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Lung capillary injury and repair in left heart disease: a new target for therapy? Clin Sci (Lond) 2014; 127:65-76. [DOI: 10.1042/cs20130296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The lungs are the primary organs affected in LHD (left heart disease). Increased left atrial pressure leads to pulmonary alveolar–capillary stress failure, resulting in cycles of alveolar wall injury and repair. The reparative process causes the proliferation of MYFs (myofibroblasts) with fibrosis and extracellular matrix deposition, resulting in thickening of the alveolar wall. Although the resultant reduction in vascular permeability is initially protective against pulmonary oedema, the process becomes maladaptive causing a restrictive lung syndrome with impaired gas exchange. This pathological process may also contribute to PH (pulmonary hypertension) due to LHD. Few clinical trials have specifically evaluated lung structural remodelling and the effect of related therapies in LHD. Currently approved treatment for chronic HF (heart failure) may have direct beneficial effects on lung structural remodelling. In the future, novel therapies specifically targeting the remodelling processes may potentially be utilized. In the present review, we summarize data supporting the clinical importance and pathophysiological mechanisms of lung structural remodelling in LHD and propose that this pathophysiological process should be explored further in pre-clinical studies and future therapeutic trials.
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Bone marrow-derived progenitor cells contribute to lung remodelling after myocardial infarction. Cardiovasc Pathol 2007; 16:321-8. [PMID: 18005870 DOI: 10.1016/j.carpath.2007.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 04/10/2007] [Accepted: 04/12/2007] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Congestive heart failure (CHF) causes structural modifications of the lungs that contribute to the functional limitations of affected subjects. We hypothesized that bone marrow-derived progenitor cells could contribute to lung structural remodelling after myocardial infarction (MI). METHODS Wistar rats were irradiated and received a bone marrow transplant (BMT) from green fluorescent protein (GFP) transgenic rats, followed 5 weeks later by coronary artery ligation or sham operation. Five weeks after MI, lung immunofluorescence studies were performed and GFP expression evaluated by Western immunoblotting. RESULTS After MI, rats developed lung structural remodelling characterized by myofibroblast (MF) proliferation in the alveolar septa. After BMT, some GFP+ cells were found in the lungs of sham animals. The amount of GFP+ cells in the lungs of MI rats was greatly increased with evidence of differentiation into MFs, as evaluated by co-localization correlation analysis with smooth muscle alpha-actin (P<.01). These cells were particularly abundant in the perivenular regions where they incorporated into the wall of blood vessels. There was a threefold increase in lung GFP protein expression after MI (P=.01). CONCLUSIONS After MI, bone marrow-derived progenitor differentiates into lung MFs. This novel pathophysiologic process may contribute to the pulmonary manifestations of CHF and could have significant therapeutic implications.
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Snyder EM, Turner ST, Johnson BD. β 2 -Adrenergic Receptor Genotype and Pulmonary Function in Patients With Heart Failure. Chest 2006; 130:1527-34. [PMID: 17099033 DOI: 10.1378/chest.130.5.1527] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Chronic heart failure (CHF) is associated with neurohumoral activation and decrements in pulmonary function (PF). The beta2-adrenergic receptor (ADRB2) modulates airway smooth muscle tone and influences lung fluid clearance. Common polymorphisms of the ADRB2 are associated with differences in ADRB2 function and therefore could differentially influence PF in patients with CHF. METHODS We studied baseline PF according to genetic variations of the ADRB2 at amino acid 16 (ie, arginine [Arg] or glycine [Gly]) in 126 CHF patients (mean [+/- SEM] age, 56 +/- 1 years; left ventricular ejection fraction [LVEF], 29 +/- 1%; body mass index [BMI], 28 +/- 0.4 kg/m2) and in 100 healthy control subjects (mean age, 50 +/- 2 years; LVEF, 63 +/- 0.7%; BMI, 25 +/- 0.3 kg/m2). RESULTS Venous epinephrine levels did not differ between CHF patients and control subjects or across genotype groups; however, norepinephrine levels were higher in CHF patients and was greater in ArgArg patients compared to GlyGly patients (p < 0.05). PF did not differ according to genotype in control subjects; however, CHF patients who were homozygous for Arg had reduced PF relative to heterozygotes or those subjects who were homozygous for Gly (vital capacity: ArgArg group, 82 +/- 3% predicted; ArgGly group, 92 +/- 2% predicted; GlyGly group, 93 +/- 2% predicted; FVC: ArgArg group, 77 +/- 3% predicted; ArgGly group, 89 +/- 2% predicted; GlyGly group, 90 +/- 2% predicted; FEV1: ArgArg group, 75 +/- 4% predicted; ArgGly group, 86 +/- 3% predicted; GlyGly group, 87 +/- 2% predicted; diffusing capacity of the lung for carbon monoxide: ArgArg group, 76 +/- 4% predicted; ArgGly group, 83 +/- 2% predicted; GlyGly group, 85 +/- 2% predicted; p < 0.05). In addition, there was a modest correlation between mitral valve inflow deceleration time and PF in CHF patients (r = 0.42; p < 0.01), but not in control subjects. CONCLUSIONS These data suggest that genetic variation of the ADRB2 is associated with differences in PF in CHF patients but not in healthy subjects, which may be related to an increased susceptibility of the homozygous Arg subjects to agonist-mediated desensitization of ADRB2s in the lungs, or related to an influence of this polymorphism on cardiac diastolic properties.
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Affiliation(s)
- Eric M Snyder
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Petersen CL, Kjaer A. Impact of medical treatment on lung diffusion capacity in elderly patients with heart failure. Baseline characteristics and 1-year follow up after medical treatment. Int J Cardiol 2005; 98:453-7. [PMID: 15708179 DOI: 10.1016/j.ijcard.2003.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Revised: 12/23/2003] [Accepted: 12/25/2003] [Indexed: 11/22/2022]
Abstract
AIM The aim of this investigation was (1) to study the effect of untreated chronic heart failure (CHF) on alveolar membrane diffusion capacity (transfer coefficient, K(CO)) in elderly patients and (2) to study the impact of the standard regime of medical treatment with diuretics and ACE-inhibitor/angiotensin-II receptor antagonists on K(CO) in these patients. METHODS Non-medicated patients (except for diuretics) with symptoms of heart failure (NYHA II-III) and echocardiographically estimated left ventricular ejection fraction (LVEF) <0.40 were recruited. All were characterized according to the results of multiple ECG-gated radionuclide ventriculography (MUGA). LVEF<0.50 when measured by MUGA was considered as heart failure (HF). A total of 20 patients fulfilled the criteria. All patients had a lung function test including measurement of K(CO) and a MUGA for LVEF measurement performed prior to medical treatment (baseline) and after 1 year of treatment with diuretics and ACE-inhibitors/angiotensin-II receptor antagonists. Age- and gender-matched healthy volunteers were included as control group. RESULTS (mean+/-S.E.M.): K(CO) at baseline was 0.95+/-0.06 and 1.25+/-0.04 mmol/min x kPa/l in HF patients and controls, respectively (p<0.05). After 1 year of treatment, K(CO) was normalized in the HF group (1.23+/-0.13 mmol/s x kPa, p<0.05). LVEF increased in the HF group from 0.28+/-0.03 at baseline to 0.34+/-0.03 after 1 year of treatment (p<0.05). CONCLUSION Elderly patients with symptomatic HF (NYHA II-III) and reduced systolic function have respiratory dysfunction in the form of reduced K(CO). One year of medical treatment had a significant beneficial effect on K(CO) and LVEF.
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Affiliation(s)
- Claus Leth Petersen
- Department of Clinical Physiology and Nuclear Medicine, H:S Frederiksberg Hospital, University of Copenhagen, Ndr. Fasanvej 57, 2000 F, Copenhagen, Denmark.
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Newall C, Schinke S, Savage CO, Hill S, Harper L. Impairment of lung function, health status and functional capacity in patients with ANCA-associated vasculitis. Rheumatology (Oxford) 2005; 44:623-8. [PMID: 15695298 DOI: 10.1093/rheumatology/keh548] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the effects of lung involvement on respiratory function in patients with ANCA-associated vasculitis and the relation to impaired health status. METHODS Thirty patients with ANCA-associated vasculitis in remission (15 with lung involvement at diagnosis as determined by an abnormal chest X-ray) were examined. We measured lung function, skeletal muscle strength [quadriceps force (QF), respiratory muscle strength (Pi(max))], exercise capacity (VO(2) peak) using treadmill exercise tests, and health status using the Short Form 36 and St George's respiratory questionnaires. RESULTS Exercise capacity was reduced compared with predicted values (58.2%, range 23-123%) and 18 patients showed functional aerobic impairment. Respiratory muscle function was reduced (72.1% predicted, range 20-108%) and was not related to lung involvement or steroid usage. Transfer factor correlated significantly with exercise capacity, suggesting inadequate delivery of oxygen to muscles. Nine patients had reduced transfer factor (seven with lung involvement). Patients with lung involvement had impaired gas transfer compared with those without lung involvement (96.9 +/- 6 vs 113.3 +/- 4.7% predicted, P = 0.04). However, there were significant abnormalities in other lung function parameters not related to previous lung involvement (eight patients had reduced forced expiratory volume in 1 s, and five patients had reduced residual volume). Twelve patients (five with previous lung involvement) had obstructive airways disease. Physical health status was impaired to a greater degree than mental health status across the whole group and was not related to lung involvement or original disease severity, but correlated with transfer factor. CONCLUSION Patients with ANCA-associated disease may have significant lung function impairment irrespective of lung involvement at the time of diagnosis. Patients showed reduced respiratory muscle strength, health status and exercise capacity, which correlated with reduced transfer factor.
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Affiliation(s)
- C Newall
- Division of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Zanen P, Folgering H, Lammers JWJ. Flow-volumes indices as means to discriminate between intra- and extrapulmonary restrictive disease. Respir Med 2005; 99:825-9. [PMID: 15939244 DOI: 10.1016/j.rmed.2004.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2004] [Indexed: 10/25/2022]
Abstract
Restrictive lung disease comes in two major categories: (1) intrapulmonary (= parenchymal) disease caused by fibrotic reactions or (2) extrapulmonary (= compression), like in heart failure. In the first category the conducting airways, tethered in stiffened structures, are less likely to be compressed during forceful expiration and expiratory flows hence are expected to remain high. This could serve as a cheap and easy diagnostic, avoiding more complicated measures. A database was build containing 624 patients suffering from either intra- and extrapulmonary disease. The flow-volume curve indices of restrictive patients (with a total lung capacity < -1.96 sd of reference) were compared and it was shown that in primary fibrotic disease and in leukaemia, indeed, the PEF and MEF(75/50/25) were significantly higher compared to the heart failure group (P < or = 0.001). The diabetes mellitus vs. heart failure differences were much less (P > 0.05). The area under the ROC to discriminate extra- from intrapulmonary disease was a low 0.607 and 0.606 for the PEF and MEF75, respectively. For the peakflow an optimal cut-off point was found at 65.8% of the reference value. The positive/negative predictive value of a peakflow < 65.8% to detect extrapulmonary disease was 30.1% and 82.2%, respectively.
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Affiliation(s)
- Pieter Zanen
- Department of Pulmonary Diseases, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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