Open AccessEffects of exercise on thoracic blood volumes, lung fluid accumulation, and pulmonary diffusing capacity in heart failure with preserved ejection fraction
Author(s) -
Caitlin C. Fermoyle,
Glenn M. Stewart,
Barry A. Borlaug,
Bruce D. Johnson
Publication year - 2020
Publication title -
american journal of physiology. regulatory, integrative and comparative physiology/american journal of physiology. regulatory, integrative, and comparative physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.266
H-Index - 175
eISSN - 1522-1490
pISSN - 0363-6119
DOI - 10.1152/ajpregu.00192.2020
Subject(s) - dlco , medicine , cardiology , diffusing capacity , lung , heart failure with preserved ejection fraction , lung volumes , supine position , stroke volume , perfusion , pulmonary diffusing capacity , heart failure , ejection fraction , lung function
Patients with heart failure with preserved ejection fraction (HFpEF) experience symptoms of exertional dyspnea that may be related to lung fluid accumulation during exercise. A computed tomography (CT)-based method was used to measure exercise-induced changes in extravascular lung fluid content and thoracic blood volumes and to determine the effect of lung fluid on lung diffusing capacity for carbon monoxide (DL CO ) in stable subjects with HFpEF and healthy controls. Nine subjects with HFpEF (age = 68 ± 8 yr; body mass index = 32.1 ± 2.6 kg/m 2 ) and eight healthy controls (62 ± 9 yr, 23.8 ± 2.4 kg/m 2 ) performed triplicate rebreathe DL CO /DL NO (lung diffusing capacity for nitric oxide) tests in a supine position at rest and duplicate measurements during two 5-min submaximal exercise stages (15W and 35W) and recovery. Subjects subsequently performed a 5-min exercise bout (35W) inside a CT scanner, and extravascular lung fluid content and thoracic blood volumes were quantified at rest and immediately following exercise from thoracic and contrast perfusion scans, respectively. Subjects with HFpEF had a higher lung fluid content at rest compared with controls (means ± SD, HFpEF: 14.4 ± 1.7%, control: 12.8 ± 1.7%, P = 0.043) and a higher lung fluid content following exercise (15.2 ± 2.0% vs. 12.6 ± 1.5%, P = 0.009). Higher lung fluid content was associated with a lower DL CO and alveolar-capillary membrane conductance (D m ) in subjects with HFpEF (DL CO : R = -0.57, P = 0.022, D m : R = -0.61, P = 0.012) but not in controls. Pulmonary blood volume was not altered by exercise and was similar between groups. Submaximal exercise elicited a greater accumulation of lung fluid in subjects with HFpEF compared with in controls, and lung fluid content was negatively correlated with lung diffusing capacity and alveolar-capillary membrane conductance in subjects with HFpEF.