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Marco Guazzi - One of the best experts on this subject based on the ideXlab platform.

  • alveolar capillary membrane conductance is the best pulmonary function correlate of exercise Ventilation efficiency in heart failure patients
    European Journal of Heart Failure, 2005
    Co-Authors: Gabriele Tumminello, Giuseppe Reina, Marco Guazzi
    Abstract:

    Background In heart failure (HF), changes in lung mechanics and gas diffusion are limiting factors to exercise. Their contribution to an increased exercise Ventilation to CO2 production (VE/VCO2) slope is undefined. Methods A total of 67 stable HF patients underwent cardiopulmonary exercise and pulmonary function tests, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), Maximal Voluntary Ventilation (MVV), total lung capacity (TLC) and alveolar diffusing capacity with its subcomponents (alveolar-capillary membrane conductance (Dm) and capillary blood volume (Vc)). Results: Patients showed a mild restrictive pattern (FEV1=85±15% and FVC=75±13% of normal predicted) and a moderate Dm reduction (32±12 ml min−1 mm Hg−1). Average peak VO2 was 15.6±4.0 ml min−1 kg−1 and the VE/VCO2 slope was 39.6±11.0. At simple Spearman correlation analysis, all variables, but Vc, correlated with peak VO2; only Dm correlated with VE/VCO2 slope. At partial Spearman correlation, all variables lost the peak VO2 correlation, and Dm still inversely correlated with VE/VCO2 slope (r=−0.35; p=0.005). In patients with a high VE/VCO2 slope (cutoff value 34), despite comparable lung volumes, Dm was significantly more depressed (30±13 vs. 35±10 ml min−1 mm Hg−1; p<0.01). Conclusions: Pulmonary function tests and alveolar gas diffusing capacity poorly correlate with peak VO2. Dm impairment rather than lung volumes correlates with exercise Ventilation efficiency. This finding further adds to the pathophysiological relevance of an abnormal gas exchange in HF patients.

  • alveolar capillary membrane gas conductance a novel prognostic indicator in chronic heart failure
    European Heart Journal, 2002
    Co-Authors: Marco Guazzi, Piergiuseppe Agostoni, Gianluca Pontone, Roberto Brambilla, Giuseppe Reina
    Abstract:

    Aims Lung dysfunction occurring in chronic heart failure worsens clinical status and exercise performance. The prognostic value of airway and alveolar function measurements in chronic heart failure has not been explored. We aimed to evaluate the prognostic value of lung function tests in a population of patients with stable chronic heart failure. Methods and Results One hundred and six stable chronic heart failure patients (whose left ventricular ejection fraction averaged 33±1%) underwent echocardiography, metabolic stress testing, assessment of pulmonary function at rest (by spirometry), of alveolar diffusing capacity (DLco) (with carbon monoxide technique) and of its membrane (DM) and capillary blood volume (Vc) components. Prognostic relevance of pulmonary variables was assessed by the Kaplan–Meier approach with log-rank testing and by Cox regression analysis. Cut-off values of lung parameters were based on the 33rd and 66th centiles. Seventeen patients died for cardiac reasons. Non-survivors compared to survivors showed lower forced expiratory volume in 1s (2·1±0·1 vs 2·4±0·1l; P <0·01), forced vital capacity (2·6±0·1 vs 2·9±0·1l; P <0·01), Maximal Voluntary Ventilation (80·7±2·5vs 95·4±2·7l; P <0·01), DLco (16·5±1·1 vs 19·3±0·6ml.min−1.mmHg−1; P <0·01) and DM (25·1±1·8 vs 31·9±1·5ml.min−1.mmHg−1; P <0·01). They also exhibited a smaller peak VO2 (14·6±0·7 vs 15·9±0·6ml.min−1.kg−1; P <0·05) and a steeper VE/VCO2 slope (45·0±1·7 vs 41·9±1·5; P <0·01). Multivariate analysis revealed that DM was the only independent predictor of cardiac death. Cases at high risk for adverse outcome were identified by a DM<24·7ml.min−1.mmHg−1. Patients receiving ACE-inhibitors presented with a higher DM (32·1±1·7 vs 27·9±1·7ml.min−1.mmHg−1, P <0·05) as well as a better Cox estimated survival rate. Conclusions Impaired DM is a powerful independent predictor of worse prognosis in stable chronic heart failure and may be considered an additional index of disease severity, as well as a specific therapeutic target.

  • lack of improvement of lung diffusing capacity following fluid withdrawal by ultrafiltration in chronic heart failure
    Journal of the American College of Cardiology, 2000
    Co-Authors: Piergiuseppe Agostoni, Maurizio Bussotti, Marco Grazi, Marco Guazzi, Pietro Palermo, Giancarlo Marenzi
    Abstract:

    Abstract OBJECTIVES We sought to investigate the possibility that lung diffusing capacity reduction observed in chronic heart failure is reversible in the short term. BACKGROUND Mechanical properties of the lung usually ameliorate with antifailure treatment including drugs, ultrafiltration and heart transplantation, whereas lung diffusion rarely improves. METHODS We studied the mechanical properties of the lung (pulmonary function tests with determination of alveolar volume, extravascular lung fluids and lung tissue), lung diffusion for carbon monoxide (DLco), including membrane diffusing capacity (Dm), pulmonary capillary blood volume (Vc) and pulmonary hemodynamics, in 28 patients with stable chronic heart failure, before a single session of extracorporeal ultrafiltration (3973 ± 2200 ml) and four days thereafter. Lung mechanics and diffusion were also evaluated in 18 normal subjects. RESULTS Vital capacity, forced expiratory volume (1 s) and Maximal Voluntary Ventilation were lower in patients when compared with normal subjects, and increased after ultrafiltration from 2.1 ± 0.7 to 2.5 ± 0.7(l)∗, 1.7 ± 0.5 to 2.0 ± 0.6(l)∗ and 67 ± 25 to 79 ± 26 (l/min)∗, respectively (∗ p CONCLUSIONS In chronic heart failure, ultrafiltration improves volumes and mechanical properties of the lung by reducing lung fluids. Diffusion is unaffected by ultrafiltration, suggesting that, in chronic heart failure, the alveolar-capillary membrane abnormalities are fluid-independent.

Giuseppe Reina - One of the best experts on this subject based on the ideXlab platform.

  • alveolar capillary membrane conductance is the best pulmonary function correlate of exercise Ventilation efficiency in heart failure patients
    European Journal of Heart Failure, 2005
    Co-Authors: Gabriele Tumminello, Giuseppe Reina, Marco Guazzi
    Abstract:

    Background In heart failure (HF), changes in lung mechanics and gas diffusion are limiting factors to exercise. Their contribution to an increased exercise Ventilation to CO2 production (VE/VCO2) slope is undefined. Methods A total of 67 stable HF patients underwent cardiopulmonary exercise and pulmonary function tests, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), Maximal Voluntary Ventilation (MVV), total lung capacity (TLC) and alveolar diffusing capacity with its subcomponents (alveolar-capillary membrane conductance (Dm) and capillary blood volume (Vc)). Results: Patients showed a mild restrictive pattern (FEV1=85±15% and FVC=75±13% of normal predicted) and a moderate Dm reduction (32±12 ml min−1 mm Hg−1). Average peak VO2 was 15.6±4.0 ml min−1 kg−1 and the VE/VCO2 slope was 39.6±11.0. At simple Spearman correlation analysis, all variables, but Vc, correlated with peak VO2; only Dm correlated with VE/VCO2 slope. At partial Spearman correlation, all variables lost the peak VO2 correlation, and Dm still inversely correlated with VE/VCO2 slope (r=−0.35; p=0.005). In patients with a high VE/VCO2 slope (cutoff value 34), despite comparable lung volumes, Dm was significantly more depressed (30±13 vs. 35±10 ml min−1 mm Hg−1; p<0.01). Conclusions: Pulmonary function tests and alveolar gas diffusing capacity poorly correlate with peak VO2. Dm impairment rather than lung volumes correlates with exercise Ventilation efficiency. This finding further adds to the pathophysiological relevance of an abnormal gas exchange in HF patients.

  • alveolar capillary membrane gas conductance a novel prognostic indicator in chronic heart failure
    European Heart Journal, 2002
    Co-Authors: Marco Guazzi, Piergiuseppe Agostoni, Gianluca Pontone, Roberto Brambilla, Giuseppe Reina
    Abstract:

    Aims Lung dysfunction occurring in chronic heart failure worsens clinical status and exercise performance. The prognostic value of airway and alveolar function measurements in chronic heart failure has not been explored. We aimed to evaluate the prognostic value of lung function tests in a population of patients with stable chronic heart failure. Methods and Results One hundred and six stable chronic heart failure patients (whose left ventricular ejection fraction averaged 33±1%) underwent echocardiography, metabolic stress testing, assessment of pulmonary function at rest (by spirometry), of alveolar diffusing capacity (DLco) (with carbon monoxide technique) and of its membrane (DM) and capillary blood volume (Vc) components. Prognostic relevance of pulmonary variables was assessed by the Kaplan–Meier approach with log-rank testing and by Cox regression analysis. Cut-off values of lung parameters were based on the 33rd and 66th centiles. Seventeen patients died for cardiac reasons. Non-survivors compared to survivors showed lower forced expiratory volume in 1s (2·1±0·1 vs 2·4±0·1l; P <0·01), forced vital capacity (2·6±0·1 vs 2·9±0·1l; P <0·01), Maximal Voluntary Ventilation (80·7±2·5vs 95·4±2·7l; P <0·01), DLco (16·5±1·1 vs 19·3±0·6ml.min−1.mmHg−1; P <0·01) and DM (25·1±1·8 vs 31·9±1·5ml.min−1.mmHg−1; P <0·01). They also exhibited a smaller peak VO2 (14·6±0·7 vs 15·9±0·6ml.min−1.kg−1; P <0·05) and a steeper VE/VCO2 slope (45·0±1·7 vs 41·9±1·5; P <0·01). Multivariate analysis revealed that DM was the only independent predictor of cardiac death. Cases at high risk for adverse outcome were identified by a DM<24·7ml.min−1.mmHg−1. Patients receiving ACE-inhibitors presented with a higher DM (32·1±1·7 vs 27·9±1·7ml.min−1.mmHg−1, P <0·05) as well as a better Cox estimated survival rate. Conclusions Impaired DM is a powerful independent predictor of worse prognosis in stable chronic heart failure and may be considered an additional index of disease severity, as well as a specific therapeutic target.

Vinicius Cavalheri - One of the best experts on this subject based on the ideXlab platform.

  • maximum Voluntary Ventilation is more strongly associated with energy expenditure during simple activities of daily living than measures of airflow obstruction or respiratory muscle strength in patients with copd
    Chronic Respiratory Disease, 2012
    Co-Authors: Vinicius Cavalheri, Kylie Hill, Leila Donaria, Carlos Augusto Camillo, Fabio Pitta
    Abstract:

    This is a retrospective analysis of data in which we explored the association between energy expenditure (EE) and lung function in patients with chronic obstructive pulmonary disease (COPD). A total of 36 participants (20 males; forced expiratory volume in 1 second (FEV(1)) of 48 ± 15% predicted) underwent measures of indirect calorimetry whilst performing five simple activities of daily living. Maximal Voluntary Ventilation was the only lung function parameter associated with EE. These data highlight the limited extent to which the FEV(1) is related to the functional performance of patients with COPD.

  • maximum Voluntary Ventilation is a better correlate of energy expenditure during simple activities of daily living than measures of airflow obstruction or respiratory muscle strength in patients with copd
    European Respiratory Journal, 2012
    Co-Authors: Vinicius Cavalheri, Kylie Hill, Leila Donaria, Carlos Augusto Camillo, Fabio Pitta
    Abstract:

    Background: In patients with chronic obstructive pulmonary disease (COPD), the relationship between energy expenditure (EE) and measures of lung function has attracted attention. Weak to moderate associations were demonstrated between daily EE and measures of respiratory muscle strength, Maximal Voluntary Ventilation (MVV), inspiratory capacity (IC) and forced expiratory volume in one second (FEV1) in patients with moderate to severe disease. However, as this earlier work measured EE over a 12-hour period, it is unclear to what extent the EE elicited during individual and simple activities of daily living were associated with these measures of lung function. Objective: To explore the extent to which energy expenditure (EE) elicited during individual and simple activities of daily living is associated with different measures of lung function in patients with COPD. Methods: Thirty-six patients (20 males; FEV1 48±15%predicted; body mass index 25.7± 8 kg·m-2) underwent assessment of lung function followed by measures of indirect calorimetry whilst performing five simple activities of daily living (modified from the Glittre-test). Results: MVV was the only parameter of lung function associated with EE elicited during each activity of daily living as well as with the total EE over the 5 tasks (0.39

Piergiuseppe Agostoni - One of the best experts on this subject based on the ideXlab platform.

  • alveolar capillary membrane gas conductance a novel prognostic indicator in chronic heart failure
    European Heart Journal, 2002
    Co-Authors: Marco Guazzi, Piergiuseppe Agostoni, Gianluca Pontone, Roberto Brambilla, Giuseppe Reina
    Abstract:

    Aims Lung dysfunction occurring in chronic heart failure worsens clinical status and exercise performance. The prognostic value of airway and alveolar function measurements in chronic heart failure has not been explored. We aimed to evaluate the prognostic value of lung function tests in a population of patients with stable chronic heart failure. Methods and Results One hundred and six stable chronic heart failure patients (whose left ventricular ejection fraction averaged 33±1%) underwent echocardiography, metabolic stress testing, assessment of pulmonary function at rest (by spirometry), of alveolar diffusing capacity (DLco) (with carbon monoxide technique) and of its membrane (DM) and capillary blood volume (Vc) components. Prognostic relevance of pulmonary variables was assessed by the Kaplan–Meier approach with log-rank testing and by Cox regression analysis. Cut-off values of lung parameters were based on the 33rd and 66th centiles. Seventeen patients died for cardiac reasons. Non-survivors compared to survivors showed lower forced expiratory volume in 1s (2·1±0·1 vs 2·4±0·1l; P <0·01), forced vital capacity (2·6±0·1 vs 2·9±0·1l; P <0·01), Maximal Voluntary Ventilation (80·7±2·5vs 95·4±2·7l; P <0·01), DLco (16·5±1·1 vs 19·3±0·6ml.min−1.mmHg−1; P <0·01) and DM (25·1±1·8 vs 31·9±1·5ml.min−1.mmHg−1; P <0·01). They also exhibited a smaller peak VO2 (14·6±0·7 vs 15·9±0·6ml.min−1.kg−1; P <0·05) and a steeper VE/VCO2 slope (45·0±1·7 vs 41·9±1·5; P <0·01). Multivariate analysis revealed that DM was the only independent predictor of cardiac death. Cases at high risk for adverse outcome were identified by a DM<24·7ml.min−1.mmHg−1. Patients receiving ACE-inhibitors presented with a higher DM (32·1±1·7 vs 27·9±1·7ml.min−1.mmHg−1, P <0·05) as well as a better Cox estimated survival rate. Conclusions Impaired DM is a powerful independent predictor of worse prognosis in stable chronic heart failure and may be considered an additional index of disease severity, as well as a specific therapeutic target.

  • lack of improvement of lung diffusing capacity following fluid withdrawal by ultrafiltration in chronic heart failure
    Journal of the American College of Cardiology, 2000
    Co-Authors: Piergiuseppe Agostoni, Maurizio Bussotti, Marco Grazi, Marco Guazzi, Pietro Palermo, Giancarlo Marenzi
    Abstract:

    Abstract OBJECTIVES We sought to investigate the possibility that lung diffusing capacity reduction observed in chronic heart failure is reversible in the short term. BACKGROUND Mechanical properties of the lung usually ameliorate with antifailure treatment including drugs, ultrafiltration and heart transplantation, whereas lung diffusion rarely improves. METHODS We studied the mechanical properties of the lung (pulmonary function tests with determination of alveolar volume, extravascular lung fluids and lung tissue), lung diffusion for carbon monoxide (DLco), including membrane diffusing capacity (Dm), pulmonary capillary blood volume (Vc) and pulmonary hemodynamics, in 28 patients with stable chronic heart failure, before a single session of extracorporeal ultrafiltration (3973 ± 2200 ml) and four days thereafter. Lung mechanics and diffusion were also evaluated in 18 normal subjects. RESULTS Vital capacity, forced expiratory volume (1 s) and Maximal Voluntary Ventilation were lower in patients when compared with normal subjects, and increased after ultrafiltration from 2.1 ± 0.7 to 2.5 ± 0.7(l)∗, 1.7 ± 0.5 to 2.0 ± 0.6(l)∗ and 67 ± 25 to 79 ± 26 (l/min)∗, respectively (∗ p CONCLUSIONS In chronic heart failure, ultrafiltration improves volumes and mechanical properties of the lung by reducing lung fluids. Diffusion is unaffected by ultrafiltration, suggesting that, in chronic heart failure, the alveolar-capillary membrane abnormalities are fluid-independent.

Fabio Pitta - One of the best experts on this subject based on the ideXlab platform.

  • maximum Voluntary Ventilation is more strongly associated with energy expenditure during simple activities of daily living than measures of airflow obstruction or respiratory muscle strength in patients with copd
    Chronic Respiratory Disease, 2012
    Co-Authors: Vinicius Cavalheri, Kylie Hill, Leila Donaria, Carlos Augusto Camillo, Fabio Pitta
    Abstract:

    This is a retrospective analysis of data in which we explored the association between energy expenditure (EE) and lung function in patients with chronic obstructive pulmonary disease (COPD). A total of 36 participants (20 males; forced expiratory volume in 1 second (FEV(1)) of 48 ± 15% predicted) underwent measures of indirect calorimetry whilst performing five simple activities of daily living. Maximal Voluntary Ventilation was the only lung function parameter associated with EE. These data highlight the limited extent to which the FEV(1) is related to the functional performance of patients with COPD.

  • maximum Voluntary Ventilation is a better correlate of energy expenditure during simple activities of daily living than measures of airflow obstruction or respiratory muscle strength in patients with copd
    European Respiratory Journal, 2012
    Co-Authors: Vinicius Cavalheri, Kylie Hill, Leila Donaria, Carlos Augusto Camillo, Fabio Pitta
    Abstract:

    Background: In patients with chronic obstructive pulmonary disease (COPD), the relationship between energy expenditure (EE) and measures of lung function has attracted attention. Weak to moderate associations were demonstrated between daily EE and measures of respiratory muscle strength, Maximal Voluntary Ventilation (MVV), inspiratory capacity (IC) and forced expiratory volume in one second (FEV1) in patients with moderate to severe disease. However, as this earlier work measured EE over a 12-hour period, it is unclear to what extent the EE elicited during individual and simple activities of daily living were associated with these measures of lung function. Objective: To explore the extent to which energy expenditure (EE) elicited during individual and simple activities of daily living is associated with different measures of lung function in patients with COPD. Methods: Thirty-six patients (20 males; FEV1 48±15%predicted; body mass index 25.7± 8 kg·m-2) underwent assessment of lung function followed by measures of indirect calorimetry whilst performing five simple activities of daily living (modified from the Glittre-test). Results: MVV was the only parameter of lung function associated with EE elicited during each activity of daily living as well as with the total EE over the 5 tasks (0.39