Clinical Investigation
Pulmonary Function Changes Associated With Cardiomegaly in Chronic Heart Failure

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Abstract

Background

This study examined the influence of increased cardiac size on maximal lung volumes, forced expiratory airflows, and the diffusing capacity of the lungs in heart failure (HF) patients compared with controls.

Methods and Results

Forty-one HF patients of New York Heart Association (NYHA) class: Group A = class I/II (n = 26) and Group B = class III/IV (n = 15) and an equal number matched controls (CTL) were recruited. Participants underwent echocardiography, spirometry, and posteroanterior and lateral chest radiographic evaluation (RAD) for volumetric estimation of the total thoracic cavity (TTC), diaphragm, heart, and lungs. Analysis of variance demonstrated no difference between groups for TTC volume (P = .63). RAD cardiac volumes (% TTC volume) were significantly different among all groups (P < .001). Echocardiograms determined left ventricular mass was elevated in the HF groups compared with the CTL group (P < .001) with no difference between HF groups. Lung volume (% TTC volume) was reduced as a function of disease severity (P < .001). RAD measures of cardiac volume demonstrated the strongest relationship with restrictive lung alterations (t-statistic = −5.627, P < .001 and t-statistic = −4.378, P < .001 for forced vital capacity and forced expiratory volume in 1 second, respectively).

Conclusions

These results suggest cardiac size may pose significant constraints on the lungs and likely plays a major role in the restrictive breathing patterns often reported in HF patients.

Section snippets

Population Characteristics

Forty-one CHF patients were recruited from the Mayo Clinic Heart Failure Service and the Cardiovascular Health Clinic (a preventive and rehabilitative center) between 2000 and 2004 (Table 1). Patients included those with a history of ischemic or dilated cardiomyopathy, stable CHF symptoms (>3 months), duration of HF symptoms >1 year, left ventricular ejection fraction ≤35%, body mass index <35 kg/m2, and current nonsmokers (past 15 years) with a smoking history <10 pack-years. Patients were

Population Characteristics

The clinical characteristics of each study group are reported in Table 1. Notable differences include a lower body mass index for the control group compared to Group B (P < .05) from a difference in body weight between groups (P < .05) as opposed to a difference in height. These differences contributed to the trend for elevated body surface area in Group B (P = .08). By definition, Group A demonstrated a greater New York Heart Association class compared with Group B (P < .05) although there

Primary Findings

CHF often results in restrictive and, to a lesser degree, obstructive changes in pulmonary function. Heart failure also is associated with gas exchange abnormalities, including reductions in DLCO. Reasons for these changes in lung function are likely multifactorial, particularly during times of decompensation. However, in stable, well-managed CHF patients who are not morbidly obese and who have a limited smoking history, increased cardiac volume may play an important role in reducing maximal

Acknowledgment

The authors thank Jacob Johnson, Kathy O'Malley, and Minelle Hulsebus for help with data acquisition and management.

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    Supported in part by: National Institutes of Health grants HL71478 and HL07111.

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