title: Hypoxia, not pulmonary vascular pressure, induces blood flow through intrapulmonary arteriovenous anastomoses.
abstract: CONCLUSIONS
  Blood flow through intrapulmonary arteriovenous anastomoses (IPAVA) is increased by acute hypoxia during rest by unknown mechanisms. Oral administration of acetazolamide blunts the pulmonary vascular pressure response to acute hypoxia, thus permitting the observation of IPAVA blood flow with minimal pulmonary pressure change. Hypoxic pulmonary vasoconstriction was attenuated in humans following acetazolamide administration and partially restored with bicarbonate infusion, indicating that the effects of acetazolamide on hypoxic pulmonary vasoconstriction may involve an interaction between arterial pH and PCO2. We observed that IPAVA blood flow during hypoxia was similar before and after acetazolamide administration, even after acid-base status correction, indicating that pulmonary pressure, pH and PCO2 are unlikely regulators of IPAVA blood flow.
  Blood flow through intrapulmonary arteriovenous anastomoses (IPAVA) is increased with exposure to acute hypoxia and has been associated with pulmonary artery systolic pressure (PASP). We aimed to determine the direct relationship between blood flow through IPAVA and PASP in 10 participants with no detectable intracardiac shunt by comparing: (1) isocapnic hypoxia (control); (2) isocapnic hypoxia with oral administration of acetazolamide (AZ; 250 mg, three times a day for 48 h) to prevent increases in PASP; and (3) isocapnic hypoxia with AZ and 8.4% NaHCO3 infusion (AZ + HCO3 (-) ) to control for AZ-induced acidosis. Isocapnic hypoxia (20 min) was maintained by end-tidal forcing, blood flow through IPAVA was determined by agitated saline contrast echocardiography and PASP was estimated by Doppler ultrasound. Arterial blood samples were collected at rest before each isocapnic-hypoxia condition to determine pH, [HCO3(-)] and Pa,CO2. AZ decreased pH (-0.08 ± 0.01), [HCO3(-)] (-7.1 ± 0.7 mmol l(-1)) and Pa,CO2 (-4.5 ± 1.4 mmHg; P < 0.01), while intravenous NaHCO3 restored arterial blood gas parameters to control levels. Although PASP increased from baseline in all three hypoxic conditions (P < 0.05), a main effect of condition expressed an 11 ± 2% reduction in PASP from control (P < 0.001) following AZ administration while intravenous NaHCO3 partially restored the PASP response to isocapnic hypoxia. Blood flow through IPAVA increased during exposure to isocapnic hypoxia (P < 0.01) and was unrelated to PASP, cardiac output and pulmonary vascular resistance for all conditions. In conclusion, isocapnic hypoxia induces blood flow through IPAVA independent of changes in PASP and the influence of AZ on the PASP response to isocapnic hypoxia is dependent upon the H(+) concentration or Pa,CO2.
authors.affiliation: Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Tremblay
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Lovering
authors.forename: Philip N
authors.initials: PN
authors.lastname: Ainslie
authors.forename: Mike
authors.initials: M
authors.lastname: Stembridge
authors.forename: Keith R
authors.initials: KR
authors.lastname: Burgess
authors.forename: Akke
authors.initials: A
authors.lastname: Bakker
authors.forename: Joseph
authors.initials: J
authors.lastname: Donnelly
authors.forename: Samuel J E
authors.initials: SJ
authors.lastname: Lucas
authors.forename: Nia C S
authors.initials: NC
authors.lastname: Lewis
authors.forename: Paolo B
authors.initials: PB
authors.lastname: Dominelli
authors.forename: William R
authors.initials: WR
authors.lastname: Henderson
authors.forename: Giulio S
authors.initials: GS
authors.lastname: Dominelli
authors.forename: A William
authors.initials: AW
authors.lastname: Sheel
authors.forename: Glen E
authors.initials: GE
authors.lastname: Foster
mesh_terms: D000086:Acetazolamide / Q000494:pharmacology; D000328:Adult; D001163:Arteriovenous Anastomosis / Q000187:drug effects / Q000502:physiology*; D001794:Blood Pressure; D002257:Carbonic Anhydrase Inhibitors / Q000494:pharmacology; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology*; D008168:Lung / Q000098:blood supply* / Q000187:drug effects; D008297:Male; D014661:Vasoconstriction; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D014665:Vasodilator Agents; D000086:Acetazolamide