title: Influence of lung volume, fluid and capillary recruitment during positional changes and exercise on thoracic impedance in heart failure.
abstract: It is unclear how dynamic changes in pulmonary-capillary blood volume (Vc), alveolar lung volume (derived from end-inspiratory lung volume, EILV) and interstitial fluid (ratio of alveolar capillary membrane conductance and pulmonary capillary blood volume, Dm/Vc) influence lung impedance (Z(T)). The purpose of this study was to investigate if positional change and exercise result in increased EILV, Vc and/or lung interstitial fluid, and if Z(T) tracks these variables.
  
  
  METHODS
  12 heart failure (HF) patients underwent measurements (Z(T), EILV, Vc/Dm) at rest in the upright and supine positions, during exercise and into recovery. Inspiratory capacity was obtained to provide consistent measures of EILV while assessing Z(T).
  
  
  RESULTS
  Z(T) increased with lung volume during slow vital capacity maneuvers (p<0.05). Positional change (upright→supine) resulted in an increased Z(T) (p<0.01), while Vc increased and EILV and Dm/Vc decreased (p<0.05). Moreover, during exercise Vc and EILV increased and Dm/Vc decreased (p<0.05), whereas, Z(T) did not change significantly (p>0.05).
  
  
  CONCLUSIONS
  Impedance appears sensitive to changes in lung volume and body position which appear to generally overwhelm small acute changes in lung fluid when assed dynamically at rest or during exercise.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States. Electronic address: Kim.chulho@mayo.edu.
authors.forename: Chul-Ho
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Fuglestad
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.
authors.forename: Maile L Ceridon
authors.initials: ML
authors.lastname: Richert
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, United States.
authors.forename: Win K
authors.initials: WK
authors.lastname: Shen
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017097:Electric Impedance; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000473:pathology* / Q000534:rehabilitation*; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000503:physiopathology*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011653:Pulmonary Diffusing Capacity
keywords: Fluid accumulation; Heart failure; Lung impedance