Studies on intragastric PCO2 at rest and during exercise as a marker of intestinal perfusion in patients with chronic heart failure.
OBJECTIVE
The aim of this study was to investigate mesenteric ischaemia by determining intragastric PCO(2) (iPCO(2)) with gastric tonometry during rest and exercise stress testing in patients with chronic heart failure (CHF). In CHF inflammatory immune activation is hypothesized to result from a chronic endotoxin challenge due to bacterial translocation of hypoperfused intestinal mucosa.


RESULTS
In 10 patients with CHF and ten healthy controls a tonometry catheter was inserted into the stomach. IPCO(2) was measured at rest and during bicycle exercise every 5 min. At rest arterial pCO(2) (aPCO(2)), intragastric pCO(2) (iPCO(2)) and the intragastric/arterial gap did not differ between patients and controls. During low level exercise (25 W), patients showed an increase in iPCO(2) compared to resting iPCO(2), whereas controls did not show an increase in iPCO(2) (change in iPCO(2): 12+/-2% vs. 1+/-0.4%, P<0.001). In CHF, iPCO(2) during peak exercise was 25+/-3% higher than at rest, compared to controls (increase 2+/-1, P<0.0001).


CONCLUSIONS
Patients with CHF already at low level exercise develop an increase in iPCO(2). This is likely to reflect hypoperfusion of the intestinal mucosa, which may contribute to the development of bacterial translocation.
Krack
Andreas
A
Department of Cardiology, Friedrich-Schiller University, Erlanger Allee 101, D-07740, Jena, Germany. andreas.krack@med.uni-jena.de
Richartz
Barbara M
BM
Gastmann
Anja
A
Greim
Kasia
K
Lotze
Ulrich
U
Anker
Stefan D
SD
Figulla
Hans R
HR
D015415:Biomarkers / Q000032:analysis / Q000097:blood; D002245:Carbon Dioxide / Q000378:metabolism*; D002908:Chronic Disease; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000378:metabolism* / Q000503:physiopathology*; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D018950:Lipopolysaccharide Receptors / Q000378:metabolism; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010477:Perfusion; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012044:Regression Analysis; D012146:Rest / Q000502:physiology*; D012964:Sodium / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D014409:Tumor Necrosis Factor-alpha; D002245:Carbon Dioxide; D019344:Lactic Acid; D012964:Sodium; D011188:Potassium