Relationship between impaired pulmonary diffusion and cardiopulmonary exercise capacity after heart transplantation.
OBJECTIVE
Diffusion impairment and reduced performance in cardiopulmonary exercise testing (CPX) have been found in patients after heart transplantation. The pathogenesis of these abnormalities is unclear. In particular, the contribution of pulmonary interstitial changes has not yet been verified.


METHODS
We analyzed pulmonary function tests, high-resolution CT (HRCT), echocardiography, left heart catheterization, and CPX in transplanted patients.


METHODS
Forty long-term survivors were studied at a median of 47 months (range, 12 to 89 months) after heart transplantation.


RESULTS
Diffusion was impaired in 40% (transfer factor for carbon monoxide) or 82.5% (carbon monoxide transfer coefficient) of the patients. Diffusion impairment was caused by a decreased diffusing capacity of the alveolar capillary membrane in 89% and/or by a decreased blood volume of the alveolar capillaries in 46% of cases. In five patients (12.5%), CT revealed interstitial lung changes. These patients did not have different values of diffusion capacity. Maximal oxygen uptake and ventilatory efficiency during exercise (minute ventilation/carbon dioxide output slope) were impaired in 92% and 46% of the cases, respectively.


CONCLUSIONS
Our data show that the diffusion abnormalities are caused by an impaired diffusion status of the alveolar capillary membrane. Interstitial changes detectable in HRCT were found not to be involved in this process. The reduced performance in CPX in our long-term survivors is caused by pulmonary perfusion abnormalities and low tidal volume, which is due to the deconditioning of respiratory muscle, rather than by interstitial changes or diffusion abnormalities.
Ewert
R
R
Deutsches Herzzentrum Berlin, Unfallkrankenhaus Berlin, Germany. rewert@dhzb.de
Wensel
R
R
Bruch
L
L
Mutze
S
S
Bauer
U
U
Plauth
M
M
Kleber
F X
FX
D000328:Adult; D006328:Cardiac Catheterization; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011379:Prognosis; D011653:Pulmonary Diffusing Capacity / Q000502:physiology*; D012189:Retrospective Studies; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed