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(Circulation. 2000;101:2774.)
© 2000 American Heart Association, Inc.

Editorial

Gas Exchange Efficiency in Congestive Heart Failure

Robert L. Johnson, Jr, MD

From the Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.

Correspondence to Robert L. Johnson, Jr, MD, Pulmonary and Critical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9034.

Key Words: Editorials • exercise • dyspnea • hyperpnea • blood gases

The lungs and heart are irrevocably linked in their oxygen and CO₂ transport functions. Functional impairment of the lungs often affects heart function, and functional impairment of the heart often affects lung function. In patients with chronic congestive heart failure (CHF), exertional dyspnea is a common symptom, and ventilatory effort is increased at a given exercise workload despite normal arterial blood gases. In this issue of Circulation, the increased exercise ventilation in CHF is reported to contain prognostic information that extends beyond that provided by maximal oxygen uptake (O_2max), left ventricular ejection fraction, or the NYHA functional classification.¹ Their data indicate that the steepness with which ventilation increases relative to CO₂ production during incremental exercise, either alone or in combination with O_2max, left ventricular ejection fraction, and NYHA classification, can be a sensitive tool for predicting event-free survival of patients with CHF. Such a tool can be important for evaluating the need for heart transplantation or for following the efficacy of therapeutic measures; it can be evaluated at submaximal work loads and is easier to measure than O_2max.

The high ventilation (E) with respect to CO₂ production (CO₂) in CHF is not a new observation,^{2 3 4 5 6} but its potential usefulness as a prognostic tool to evaluate the severity of CHF is relatively new. Perhaps even more important, however, is what the studies of Kleber et al,¹ using this tool, tell us about impaired gas exchange in CHF and its relationship to impaired . . . [Full Text of this Article]

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