Pulmonary Function Impairment in Heart Failure
Summary
Heart failure frequently coexists with significant pulmonary abnormalities that arise from elevated cardiac pressures and neurohumoral activation. Increased pulmonary capillary pressure promotes transudation of fluid into the interstitial and alveolar spaces, impairing gas exchange and reducing lung compliance. Structural changes in the alveolar–capillary membrane, together with ventilation–perfusion mismatch, contribute to a decline in diffusing capacity and exercise intolerance. Patients with chronic heart failure often exhibit a restrictive ventilatory pattern, diminished forced vital capacity and reduced forced expiratory volume, which compound exertional dyspnoea. Alterations in respiratory mechanics, such as increased airway resistance and hyperventilation relative to carbon dioxide output, further erode ventilatory efficiency. These pulmonary derangements not only exacerbate symptoms but also serve as prognostic markers, with parameters such as reduced diffusing capacity for carbon monoxide and elevated ventilatory response slopes predictive of adverse outcomes. Integrating cardiopulmonary assessment into routine management can guide therapeutic interventions, including optimising fluid balance, tailoring pharmacotherapy and employing ventilatory support strategies.
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Pulmonary Function Impairment in Heart Failure publication trend
The graph below shows the total number of articles in pulmonary function impairment in heart failure across all publications each year (not limited to Nature Index journals).
Technical terms
Alveolar–capillary membrane: Thin barrier through which oxygen and carbon dioxide diffuse between air in the alveoli and blood in pulmonary capillaries.
Diffusing capacity for carbon monoxide (DLCO): Measure of the lung’s ability to transfer gas from alveoli to blood.
Forced vital capacity (FVC): Total volume of air that can be exhaled forcefully after a maximal inhalation.
Forced expiratory volume in one second (FEV1): Volume of air expelled in the first second of a forced exhalation, indicating airway patency.
Ventilation–perfusion mismatch: Discrepancy between air reaching the alveoli and blood flow in pulmonary capillaries, leading to inefficient gas exchange.
Non‐invasive ventilation (NIV): Supportive breathing assistance delivered through a mask without endotracheal intubation.
References
- Lungs in Heart Failure. Pulmonary Medicine (2012).
- Resting pulmonary function and artery pressure and cardiopulmonary exercise testing in chronic heart failure patients in Taiwan − a prospective observational cross-sectional study comparing healthy subjects and interstitial lung disease patients. Annals of Medicine (2023).
- Impact of Sacubitril/Valsartan on surfactant binding proteins, central sleep apneas, lung function tests and heart failure biomarkers: Hemodynamic or pleiotropism?. Frontiers in Cardiovascular Medicine (2022).
- Association of lung diffusion capacity with cardiac remodeling and risk of heart failure: The Framingham heart study. PLOS ONE (2021).
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