title: Reduction in membrane component of diffusing capacity is associated with the extent of acute pulmonary embolism.
abstract: Acute pulmonary embolism (PE) often decreases pulmonary diffusing capacity for carbon monoxide (DL,CO), but data on the mechanisms involved are inconsistent. We wanted to investigate whether reduction in diffusing capacity of alveolo-capillary membrane (DM) and pulmonary capillary blood volume (Vc) is associated with the extent of PE or the presence and severity of right ventricular dysfunction (RVD) induced by PE and how the possible changes are corrected after 7-month follow-up. Forty-seven patients with acute non-massive PE in spiral computed tomography (CT) were included. The extent of PE was assessed by scoring mass of embolism. DL,CO, Vc, DM and alveolar volume (VA) were measured by using a single breath method with carbon monoxide and oxygen both at the acute phase and 7 months later. RVD was evaluated with transthoracic echocardiography and electrocardiogram. Fifteen healthy subjects were included as controls. DL,CO, DL, CO/VA, DM, vital capacity (VC) and VA were significantly lower in the patients with acute PE than in healthy controls (P < 0.001). DM/Vc relation was significantly lower in patients with RVD than in healthy controls (P = 0.004). DM correlated inversely with central mass of embolism (r = -0.312; P = 0.047) whereas Vc did not. DM, DL,CO, VC and VA improved significantly within 7 months. In all patients (P = 0.001, P = 0.001) and persistent RVD (P = 0.020, P = 0.012), DM and DL,CO remained significantly lower than in healthy controls in the follow-up. DM was inversely related to central mass of embolism. Reduction in DM mainly explains the sustained decrease in DL,CO in PE after 7 months despite modern treatment of PE.
authors.affiliation: Department of Clinical Physiology, HUSLAB, Helsinki University Central Hospital, Finland. paivi.piirila@hus.fi
authors.forename: Päivi
authors.initials: P
authors.lastname: Piirilä
authors.forename: Mia
authors.initials: M
authors.lastname: Laiho
authors.forename: Pirjo
authors.initials: P
authors.lastname: Mustonen
authors.forename: Marit
authors.initials: M
authors.lastname: Graner
authors.forename: Anneli
authors.initials: A
authors.lastname: Piilonen
authors.forename: Merja
authors.initials: M
authors.lastname: Raade
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Anssi
authors.initials: A
authors.lastname: Sovijärvi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015824:Blood-Air Barrier / Q000378:metabolism*; D001944:Breath Tests; D002245:Carbon Dioxide / Q000097:blood*; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005387:Finland; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011652:Pulmonary Circulation; D011653:Pulmonary Diffusing Capacity; D011655:Pulmonary Embolism / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D013147:Spirometry; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D016278:Ventricular Function, Right
chemical_list: D005343:Fibrinolytic Agents; D002245:Carbon Dioxide