Abstract
Investigations have described a correlation between the severity of heart failure and the severity of pulmonary function abnormalities. In this study, we investigated the association of resting spirometric parameters, lung diffusion for carbon monoxide (DLCO), and the transfer coefficient (KCO) with hemodynamic variables and outcomes in a cohort of heart transplant candidates. Between January 2018 and January 2020, a total of 100 patients with advanced heart failure who were scheduled for right heart catheterization (RHC) as a pre-transplant evaluation measure were enrolled. Spirometry and DLCO were performed in all patients within 24 hours of their RHC. All selected patients were followed for a median (IQR) time of 6 (2-12) months. The end points of interest were heart failure-related mortality and a combined event involving HF-related mortality, heart transplantation (HTX), and need for the placement of a left ventricular assist device (LVAD). Among 846 patients scheduled for RHC, a total of 100 patients (25% female) with a mean (SD) age of 38.5 (12.8) were enrolled. There was a significant correlation between FEV1/FVC and CVP (r = -0.22, p = 0.02), PCWP (r = -0.4, p < 0.001), mPAP (r = -0.45, p < 0.001), and PVR (r = -0.32, p = 0.001). The cardiac output correlated with DLCO (r = 0.3, p = 0.008). Spirometry parameters, DLCO parameters, and hemodynamic parameters did not correlate with the combined event. Among the several variables, only PVR had an independent association with the combined event. Both mechanical and gas diffusion parameters of the lung were not associated with outcomes in the homogeneous group of heart transplant candidates.
Highlights
Investigations have described a correlation between the severity of heart failure and the severity of pulmonary function abnormalities
Inclusion criteria: — Patients with advanced heart failure according to the European Society of Cardiology [2] who were scheduled for pre-transplant evaluation or left ventricular assist device (LVAD) implantation for the first time; — On optimal guideline-directed medical therapies (GDMT) [2]; — Patients who had interagency registry for mechanically assisted circulatory support (INTERMACS) clinical profiles of 3 or 4 [14]
We showed that FEV1/FVC, KCO, and %KCO could be correlated with hemodynamic measures in HTX candidates
Summary
Investigations have described a correlation between the severity of heart failure and the severity of pulmonary function abnormalities. The abnormal pulmonary capillary hemodynamics in heart failure caused by increases in interstitial and alveolar edema result in impairment of lung mechanics, resistance in membrane conductance, and decreased gas transfer [3,4,5]. Both restrictive and obstructive patterns have been seen in patients with heart failure, the mechanical impairment of the lungs in HF is commonly a restrictive lung disease shown by a preserved forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio with a progressively lower FEV1, FVC, and alveolar volume (VA) as HF severity increases [3, 6]. The severity of mechanical impairment of the lungs correlates with exercise capacity
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