Rest and Exercise Cardiac Output and Diffusing Capacity Assessed By a Single Slow Exhalation of Methane, Acetylene, and Carbon Monoxide

Abstract

To study rest and exercise pulmonary capillary blood flow (Qc) and diffusing capacity (DLexh) assessed by the rapid analysis of methane, acetylene, and carbon monoxide during a single, slow exhalation, we evaluated 36 subjects during first-pass radionuclide angiography (RNA). At rest (N = 36) and at exercise (N = 21) there was no difference in the respective measurements of cardiac output (Qc = 6.0 +/- 1.7 and CORNA = 6.9 +/- 2.5 at rest; Qc = 13.7 +/- 3.2 and CORNA = 14.5 +/- 4.1 at exercise, L/min, mean +/- SD, r = .80). Mild maldistribution of ventilation, as manifested by an increased phase 3 alveolar slope for methane (CH4 slope), did not significantly influence the results. CH4 slope and DLexh did increase significantly with exercise, while total lung capacity remained unchanged (CH4 slope: 6.2 +/- 5.0 vs 12.5 +/- 6.8% delta CH4/L, mean +/- SD, p less than 0.001; Dsb: 27.7 +/- 9.2 vs 42.0 +/- 17.9 ml/min/mm Hg, mean +/- SD, p less than 0.001; TLC: 5.47 +/- .20 vs 5.96 +/- 1.20 L, mean +/- SD). DLexh was related to CORNA (r = .68) and RNA stroke volume (r = .50). Qc was significantly less than CORNA in the subset of studies with valvular regurgitation (VHD) (N = 7). On the other hand, Qc was significantly greater than CORNA in the setting of coronary artery disease (CAD) and severe wall motion abnormalities (N = 7). These differences may be attributed to regurgitant fractions in VHD, and the influence of wall motion abnormalities on the estimation of left ventricular volume by the area-length method in CAD. These two noninvasive methods compare well at rest and exercise in clinical subjects and may provide complementary information in certain cardiopulmonary diseases.