The inﬂuence of chronic heart failure on pulmonary function tests in patients undergoing orthotopic heart transplantation
M Lizak, M Zakliczyński, A Jarosz, M Zembala
Ann Transplant 2009; 14(1): 66-67
Background: Chronic heart failure and airway's obstruction have overlapping syndromes. World criteria for diagnosing and grading of airway's obstruction are based on spirometry results, but may be inadequate when cardiac failure coexists. Cardiac component of pulmonary function tests' (PFT) results can be measured in patients undergoing orthotopic heart transplantation (OHT).
Material/Methods: In 29 patients PFT were performed according to the Polish Phtisiopulmonology Society guidelines before and one year after OHT in the years 2006-2008. Willcoxon matched pairs' tests were used for analysis in Statistica 7.1. General group characteristics included age, sex, NYHA, CCS, BMI, present medication, blood tests and chemistry, exercise test, right heart catheterisation and echocardiography results.
Results: One year after OHT significant improvement in forced expiratory volume in the first second (FEV1) and its percent of predicted value (FEV1%), forced vital capacity (FVC), FVC%, vital capacity (VC) and VC% was observed (accordingly: 2.56 vs. 2.96l, 82 vs. 93%, 3.30 vs. 3.81l, 85 vs. 97%, 3.38 vs. 4.04l, 85 vs. 100%, p<0.01). FEV1 and FVC increment exceeded the cut-off point of 12% of normal value (accordingly: 0.38 and 0.47l) established as spirometry criterion for obstruction reversibility. Elimination of the heart failure by OHT did not result in signifi cant changes in FEV1 to FVC ratio (FEV1%FVC) used as main diagnostic criterion of chronic obstructive lung disease.
Conclusions: Chronic heart failure contributes to FEV1 variability of 0.4l or 12.6% of normal value which limits the usefulness of PFT in diagnosing and grading of airway obstruction in this group. Induction of inhaled betamimetics and steroids should be carefully considered and symptom-based in this group of patients since optimalisation of CHF treatment can be the best way to improve spirometry results. FEV1%FVC seems independent of concomitant heart function impairment.
Keywords: Heart Transplantation, clinical outcome