title: Lung-heart interaction as a substrate for the improvement in exercise capacity after body fluid volume depletion in moderate congestive heart failure.
abstract: We investigated exercise capacity after fluid depletion in patients with moderate congestive heart failure (CHF). Twenty-one patients underwent ultrafiltration (mean volume +/- SEM: 1,770 +/- 135 ml). Echocardiography, tests of pulmonary function, and a cardiopulmonary exercise test with hemodynamic and esophageal pressure monitoring were performed before ultrafiltration and 3 months later. Tests without invasive measurements were repeated 4 and 30 days after ultrafiltration. Twenty-one control patients followed the same protocol but did not have ultrafiltration. Patients who underwent ultrafiltration and increased their oxygen consumption at peak exercise (peak VO2) by > 10% at the 3-month evaluation (group A1, n = 9) were separated from those who did not (group A2, n = 8); 3 patients did not complete the follow-up. Four days after the procedure, peak VO2 had risen from 17.3 +/- 0.8 to 19.3 +/- 0.9 ml/min/kg in group A1, and from 11.9 +/- 0.7 to 14.1 +/- 0.7 ml/min/kg in group A2 (p < 0.01). Plasma norepinephrine and pulmonary function were consistent with a greater severity of the syndrome in group A2. At 3 months in group A1, the relations of filling pressure to cardiac index of the right and left ventricles were shifted upward; the esophageal pressure swing (differences between end-expiratory and end-inspiratory pressure) for a given tidal volume was lower; the peak exercise dynamic lung compliance had increased from 0.10 +/- 0.05 to 0.14 +/- 0.03 L/mm Hg (p < 0.01). None of these changes were detected in group A2 and control patients.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Istituto di Cardiologia, Centro Cardiologico-Fondazione Monzino, Università di Milano, Italy.
authors.forename: P G
authors.initials: PG
authors.lastname: Agostoni
authors.forename: G C
authors.initials: GC
authors.lastname: Marenzi
authors.forename: P
authors.initials: P
authors.lastname: Sganzerla
authors.forename: E
authors.initials: E
authors.lastname: Assanelli
authors.forename: M
authors.initials: M
authors.lastname: Guazzi
authors.forename: G B
authors.initials: GB
authors.lastname: Perego
authors.forename: G
authors.initials: G
authors.lastname: Lauri
authors.forename: E
authors.initials: E
authors.lastname: Doria
authors.forename: M
authors.initials: M
authors.lastname: Pepi
authors.forename: M D
authors.initials: MD
authors.lastname: Guazzi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001826:Body Fluids / Q000378:metabolism*; D004947:Esophagus / Q000503:physiopathology; D005080:Exercise Test; D017079:Exercise Tolerance; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000378:metabolism / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008170:Lung Compliance; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption; D011312:Pressure; D013990:Tidal Volume; D014462:Ultrafiltration; D017725:Ventricular Pressure
chemical_list: D009638:Norepinephrine