Acute saline infusion reduces alveolar-capillary membrane conductance and increases airflow obstruction in patients with left ventricular dysfunction

Abstract

Background - Impaired alveolar-capillary membrane conductance is the major cause for the reduction in pulmonary diffusing capacity for carbon monoxide (DLCO) in heart failure. Whether this reduction is fixed, reflecting pulmonary microvascular damage, or is variable is unknown. The aim of this study was to assess whether DLCO and its subdivisions, alveolar-capillary membrane conductance (DM) and pulmonary capillary blood volume (VC), were sensitive to changes in intravascular volume. In addition, we examined the effects of volume loading on airflow rates. Methods and Results - Ten patients with left ventricular dysfunction (LVD) and 8 healthy volunteers were studied. DM and VC were determined by the Roughton and Forster method. The forced expiratory volume in 1 second (FEV1, vital capacity, and peak expiratory flow rates (PEFR) were also recorded. In patients with LVD, infusion of 10 mL · kg-1 body wt of 0.9% saline acutely reduced DM (12.0±3.3 versus 10.4±3.5 mmol · min-1 · kPa-1, P<0.005), FEV1 (2.3±0.4 versus 2.1±0.4 L, P<0.0005), and PEFR (446±55 versus 414±56 L · min-1, P<0.005). All pulmonary function tests had returned to baseline values 24 hours later. In normal subjects, saline infusion had no measurable effect on lung function. Conclusions - Acute intravascular volume expansion impairs alveolar-capillary membrane function and increases airflow obstruction in patients with LVD but not in normal subjects. Thus, the abnormalities of pulmonary diffusion in heart failure, which were believed to be fixed, also have a variable component that could be amenable to therapeutic intervention.