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. 2000 Feb;83(2):156–160. doi: 10.1136/heart.83.2.156

The alveolar-capillary membrane diffusing capacity and the pulmonary capillary blood volume in heart transplant candidates

O Al-Rawas 1, R Carter 1, R Stevenson 1, S Naik 1, D Wheatley 1
PMCID: PMC1729318  PMID: 10648487

Abstract

OBJECTIVES—To determine the mechanism of impairment of pulmonary transfer factor for carbon monoxide (TLCO) in heart transplant candidates, as this is the most common lung function abnormality.
SETTING—Regional cardiopulmonary transplant centre.
METHODS—TLCO and its components (the diffusing capacity of the alveolar-capillary membrane (DM) and the pulmonary capillary blood volume (VC)) were measured using the Roughton and Forster method and the single breath technique in 38 patients with severe chronic heart failure awaiting heart transplantation (mean age 51 years, range 19 to 61; mean left ventricular ejection fraction 12.8%). Results were compared with data from 26 normal subjects (mean age 47 years, range 27 to 62).
RESULTS—Mean per cent predicted TLCO, DM, and VC were significantly reduced in patients (69.9%, 81.4%, and 80.2% of predicted, respectively) compared with controls (97.7%, 100.1%, and 102.3% of predicted, respectively, p < 0.001). The relative contribution of the two components of TLCO in patients was similar to that of normal subjects, with each component accounting for approximately 50% of the total resistance to diffusion (1/TLCO).
CONCLUSIONS—TLCO impairment in patients with severe chronic heart failure awaiting heart transplantation results from a proportionate reduction in both DM and VC, suggesting a significant disturbance of the pulmonary vascular bed.


Keywords: heart failure; diffusing capacity; pulmonary transfer factor; pulmonary capillary blood volume

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Figure 1  .

Figure 1  

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The graphical derivation of TLCO components (DM and VC) using the Roughton and Forster equation: a plot of 1/TLCO against 1/θ yields a straight line which intersects the ordinate 1/ TLCO at point A. At this point, the value of 1/θ equals zero and therefore the value of 1/ TLCO at point A equals 1/DM. The triangular area above the intersection represents a plot of 1/θVC against 1/θ. VC can therefore be obtained by dividing 1/θVC by 1/θ (that is, 1/VC = BC/AB), which is the slope of the line AC.

Figure 2  .

Figure 2  

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Pulmonary transfer factor for carbon monoxide (TLCO) and its components in heart transplant candidates compared with normal controls.

Figure 3  .

Figure 3  

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The total resistance to CO transfer (1/TLCO) and its components (1/DM and 1/θVC) in heart transplant candidates compared with normal controls

Figure 4  .

Figure 4  

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Scatter plots of per cent predicted pulmonary transfer factor for carbon monoxide (TLCO) against haemoglobin concentration in heart transplant candidates.

Figure 5  .

Figure 5  

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Pulmonary transfer factor for carbon monoxide (TLCO) and its components in heart transplant candidates subdivided in non-smokers (10 patients) and ex-smokers (28 patients). Differences between non-smokers and ex-smokers were not significant.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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