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(Circulation. 2001;103:916.)
© 2001 American Heart Association, Inc.

Editorial

Gas Exchange Efficiency in Congestive Heart Failure II

Robert L. Johnson, Jr, MD

From the Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas.

Correspondence to Robert L. Johnson, Jr., MD, Pulmonary and Critical Care Division, Department of Internal Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390-9034. E-mail Robert.Johnson@utsouthwestern.edu

Key Words: Editorials • heart failure • ventilation

It has become increasingly apparent that congestive heart failure (CHF) affects not only the cardiovascular system, but every organ system involved with oxygen transport, including the respiratory system, skeletal muscles, and the hormonal and neural feedback control systems for breathing, cardiac output, blood pressure, blood volume, and distribution of blood flow. One segment of this transport system cannot be isolated from the rest. The ventilatory response to exercise in patients with CHF is augmented despite normal arterial O₂ saturation and a normal or low end-tidal PCO_2.^{1 2 3 4 5 6} The augmented ventilatory response is measured as a steep slope of the increase in ventilation with respect to CO₂ output (E/CO₂) or as a high E/CO₂ ratio at peak exercise. The source of this ventilatory augmentation has been controversial, but its pathophysiological significance is clear. A high slope at submaximal exercise or a high E/CO₂ ratio at peak exercise is a powerful index of poor prognosis in patients with CHF.^{4 7} As indicated by Ponikowski et al⁸ in the current issue of Circulation, this prognostic power is retained in patients with CHF, even when the maximal O₂ uptake (O₂ max) is near the normal range.

A high E/CO₂ ratio has 2 possible sources: (1) increased ventilation, which is required to overcome a large dead space to maintain a normal arterial CO₂ tension (PaCO₂), or (2) increased central drive to ventilation, which drives the PaCO₂ below what is normally expected. . . . [Full Text of this Article]

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