This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Johnson, R. L. Search for Related Content PubMed PubMed Citation Articles by Johnson, R. L., Jr Related Collections Congestive Exercise testing Epidemiology

(Circulation. 2000;101:2774.)
© 2000 American Heart Association, Inc.

Editorial

Gas Exchange Efficiency in Congestive Heart Failure

Robert L. Johnson, Jr, MD

From the Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.

Correspondence to Robert L. Johnson, Jr, MD, Pulmonary and Critical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9034.

Key Words: Editorials • exercise • dyspnea • hyperpnea • blood gases

The lungs and heart are irrevocably linked in their oxygen and CO₂ transport functions. Functional impairment of the lungs often affects heart function, and functional impairment of the heart often affects lung function. In patients with chronic congestive heart failure (CHF), exertional dyspnea is a common symptom, and ventilatory effort is increased at a given exercise workload despite normal arterial blood gases. In this issue of Circulation, the increased exercise ventilation in CHF is reported to contain prognostic information that extends beyond that provided by maximal oxygen uptake (O_2max), left ventricular ejection fraction, or the NYHA functional classification.¹ Their data indicate that the steepness with which ventilation increases relative to CO₂ production during incremental exercise, either alone or in combination with O_2max, left ventricular ejection fraction, and NYHA classification, can be a sensitive tool for predicting event-free survival of patients with CHF. Such a tool can be important for evaluating the need for heart transplantation or for following the efficacy of therapeutic measures; it can be evaluated at submaximal work loads and is easier to measure than O_2max.

The high ventilation (E) with respect to CO₂ production (CO₂) in CHF is not a new observation,^{2 3 4 5 6} but its potential usefulness as a prognostic tool to evaluate the severity of CHF is relatively new. Perhaps even more important, however, is what the studies of Kleber et al,¹ using this tool, tell us about impaired gas exchange in CHF and its relationship to impaired . . . [Full Text of this Article]

This article has been cited by other articles:

				L. J. Olson, A. M. Arruda-Olson, V. K. Somers, C. G. Scott, and B. D. Johnson Exercise Oscillatory Ventilation: Instability of Breathing Control Associated With Advanced Heart Failure Chest, February 1, 2008; 133(2): 474 - 481. [Abstract] [Full Text] [PDF]

				D. Mancini and T. H. LeJemtel Is Ventilatory Classification Preferable to Peak Oxygen Consumption for Risk Stratification in Heart Failure? Circulation, May 8, 2007; 115(18): 2376 - 2378. [Full Text] [PDF]

				M. Guazzi Alveolar-Capillary Membrane Dysfunction in Heart Failure: Evidence of a Pathophysiologic Role Chest, September 1, 2003; 124(3): 1090 - 1102. [Abstract] [Full Text] [PDF]

				M. Arzt, M. Harth, A. Luchner, F. Muders, S. R. Holmer, F. C. Blumberg, G. A.J. Riegger, and M. Pfeifer Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Central Sleep Apnea Circulation, April 22, 2003; 107(15): 1998 - 2003. [Abstract] [Full Text] [PDF]

				R. L. Johnson Jr Gas Exchange Efficiency in Congestive Heart Failure II Circulation, February 20, 2001; 103(7): 916 - 918. [Full Text] [PDF]