title: Impact of chronic systolic heart failure on lung structure-function relationships in large airways.
abstract: Heart failure (HF) is often associated with pulmonary congestion, reduced lung function, abnormal gas exchange, and dyspnea. We tested whether pulmonary congestion is associated with expanded vascular beds or an actual increase in extravascular lung water (EVLW) and how airway caliber is affected in stable HF Subsequently we assessed the influence of an inhaled short acting beta agonist (SABA). Thirty-one HF (7F; age, 62 ± 11 years; ht. 175 ± 9 cm; wt. 91 ± 17 kg; LVEF, 28 ± 15%) and 29 controls (11F; age; 56 ± 11 years; ht. 174 ± 8 cm; wt. 77 ± 14 kg) completed the study. Subjects performed PFTs and a chest computed tomography (CT) scan before and after SABA CT measures of attenuation, skew, and kurtosis were obtained from areas of lung tissue to assess EVLW Airway luminal areas and wall thicknesses were also measured : CT tissue density suggested increased EVLW in HF without differences in the ratio of airway wall thickness to luminal area or luminal area to TLC (skew: 2.85 ± 1.08 vs. 2.11 ± 0.79, P < 0.01; Kurtosis: 15.5 ± 9.5 vs. 9.3 ± 5.5 P < 0.01; control vs. HF). PFTs were decreased in HF at baseline (% predicted FVC:101 ± 15% vs. 83 ± 18%, P < 0.01;FEV1:103 ± 15% vs. 82 ± 19%, P < 0.01;FEF25-75: 118 ± 36% vs. 86 ± 36%, P < 0.01; control vs. HF). Airway luminal areas, but not CT measures, were correlated with PFTs at baseline. The SABA cleared EVLW and decreased airway wall thickness but did not change luminal area. Patients with HF had evidence of increased EVLW, but not an expanded bronchial circulation. Airway caliber was maintained relative to controls, despite reductions in lung volume and flow rates. SABA improved lung function, primarily by reducing EVLW.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Chase
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Wheatley
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Olson
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Beck
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wentz
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Snyder
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Taylor
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota johnson.bruce@mayo.edu.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Johnson
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage; D016022:Case-Control Studies; D002908:Chronic Disease; D015633:Extravascular Lung Water / Q000378:metabolism; D005260:Female; D005541:Forced Expiratory Volume; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008450:Maximal Midexpiratory Flow Rate; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D013318:Stroke Volume; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016277:Ventricular Function, Left; D014797:Vital Capacity
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000420:Albuterol
keywords: Airway walls; CT; airways; congestion; edema