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. 2024 Jan 15;49(6):e20230368.
doi: 10.36416/1806-3756/e20230368.

Pulmonary function laboratory to assist in the management of cardiac disease

[Article in English, Portuguese]
José Alberto Neder  1 , Danilo Cortozi Berton  2 , Denis E O'Donnell  1
Affiliations

Pulmonary function laboratory to assist in the management of cardiac disease

[Article in English, Portuguese]
José Alberto Neder et al. J Bras Pneumol. .
No abstract available

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Conflict of interest statement

CONFLICTS OF INTEREST: None declared.

Figures

Figure 1
Figure 1. Respiratory functional consequences of heart failure with reduced ejection fraction (HFrEF) with the highest potential to influence the interpretation of pulmonary function tests. Panel A depicts the effects of COPD, HFrEF, and their combination on resting lung volumes and capacities in a non-obese subject. Variable degrees of thoracic hyperinflation (⇑ TLC), lung hyperinflation (⇑ FRC), and gas trapping (⇑ RV) result in low volume available (⇓ IC) for tidal volume (Vt) expansion in patients with moderate-to-severe COPD. This latter consequence is also observed in moderate-to-severe HFrEF in which the most consistent mechanical effect is a reduction in TLC that is also more pronounced than those found in FRC. In contrast to COPD, the IC decrement in HFrEF occurs predominantly due to a lower “ceiling” (TLC) rather than a higher “floor” (FRC). Lung volume measurements (e.g. body plethysmography) are particularly useful to suggest coexistent HF and COPD. HF may ‘normalize’ TLC in a COPD patient with previous thoracic hyperinflation. Conversely, high RV and RV/TLC may indicate the presence of COPD-related gas trapping as RV is more “resistant” than TLC to decrease secondary to coexistent HFrEF. Panel B provides a schematic representation of potential trajectories of lung function, hemodynamics, and body weight with progressing lung (and peripheral) congestion. As left ventricular filling pressure increases (⇑ pulmonary capillary wedge pressure; PCWP), lung congestion and interstitial edema develop, causing reductions in FVC and DLCO, while FEV1/FVC remains normal. Therefore, FVC and particularly DLCO may decline with even moderate congestion, whereas an obstructive-like pattern (low FEV1/FVC) may emerge with advanced congestion due to thickening of bronchial wall by edema and increased vascular volume, peribronchial edema, and vascular engorgement, as well as low radial distending forces on the bronchial wall due to low lung volumes and increased airway smooth muscle contractility elicited by neuro-humoral mechanisms. EILV: end-inspiratory lung volume; FRC: functional residual capacity; IRV: inspiratory reserve volume; ERV: expiratory reserve volume; IC: inspiratory capacity; and PAPm: mean pulmonary arterial pressure. Panel B reproduced with permission of the publisher.
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