Published Online
on October 27, 2003

A more recent version of this article appeared on November 25, 2003

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Submitted on May 14, 2003
Revised on July 10, 2003
Accepted on August 20, 2003

Exercise-Induced Pulmonary Edema in Heart Failure

Piergiuseppe Agostoni MD, PhD^*, Gaia Cattadori MD, Michele Bianchi MD, and Karlman Wasserman MD, PhD

From Centro Cardiologico Monzino (P.A., G.C., M.B.), IRCCS, Istituto di Cardiologia, Università di Milano, Milan, Italy; and Division of Respiratory and Critical Care Medicine (K.W.), Department of Medicine, Harbor-University of California Los Angeles Medical Center, Torrance, Calif.

^* To whom correspondence should be addressed. E-mail: Piergiuseppe.agostoni{at}CCFM.it.

Background--In heart failure (HF) patients, exercise may increase pulmonary capillary hydrostatic pressure and thereby generate pulmonary edema. If pulmonary edema developed, alveolar-capillary membrane conductance (DM), measured immediately after exercise, would decrease. To test this hypothesis, we measured DM before and at 2 and 60 minutes after exercise.

Methods and Results--We studied 10 HF patients with exercise-induced periodic breathing, 10 with peak VO₂ 15 mL · min^-1 · kg^-1 (severe HF), 10 with VO₂=15 to 20 mL · min^-1 · kg^-1 (moderate HF), and 10 normal subjects (control). Using the Roughton-Forster technique, we measured carbon monoxide diffusion capacity (DLCO) and its components, capillary blood volume (VC) and DM, at rest and 2 and 60 minutes after exercise. At rest, DLCO and DM were lowest in periodic breathing and highest in control subjects. DM decreased in periodic breathing, severe HF, and moderate HF (-7.83±3.98, -5.57±2.03, and -3.85±3.53 mL · min^-1 · mm Hg^-1, respectively; P<0.01) at 2 minutes after exercise but not in control subjects. VC increased in all groups at 2 minutes and remained elevated at 60 minutes only in periodic breathing. DM/VC was decreased in periodic breathing, severe HF, and moderate HF at 2 minutes but not in control subjects. DM and DM/VC remained low at 60 minutes only in periodic breathing.

Conclusions--DM decreases after exercise in HF patients but not in control subjects, which suggests a decrease in conductance across the alveolar-capillary barrier, as with pulmonary edema. The reductions were most marked in HF patients with periodic breathing and less reduced in less severe HF.

Key words: heart failure • exercise • edema • lung

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