Chest
Volume 103, Issue 5, May 1993, Pages 1477-1481
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Clinical Investigations
Bronchial Hyperreactivity in Patients With Moderate Pulmonary Circulation Overload

https://doi.org/10.1378/chest.103.5.1477Get rights and content

The clinical course of congestive heart failure (CHF) and mitral valve stenosis (MVS) is accompanied by episodes of dyspnea, wheezing, and cough, symptoms also observed in patients with bronchial hyperreactivity. However, it is still controversial whether bronchial hyperreactivity is demonstrable in patients with chronic overload of the pulmonary circulation. In order to examine the effects of CHF on the respiratory function, we performed pulmonary function tests, titrated bronchial acetylcholine provocations, and left and right heart catheterization in 21 patients with impaired left ventricular function (mean ejection fraction, 37 percent, NYHA class 3), 5 patients with MVS, and 17 control patients with coronary artery disease (mean ejection fraction, 63 percent). Bronchial hyperresponsiveness was defined as an obstructive response to increased doses of inhaled acetylcholine. A 20 percent fall in forced expiratory volume in the first second (FEV1), a 100 percent increase in total airway resistance (Rtot), and a 60 percent reduction of pulmonary conductance (SGtot) were considered positive. Patients with impaired left ventricular function showed significantly higher airway resistance, and lower airway conductance at the maximal tolerated acetylcholine dose compared with control patients. Patients with MVS had a significant lower airway conductance. The induced bronchial obstruction was completely reversible upon inhalation of a β2-mimetic. We condude that chronic overload of the pulmonary circulation is accompanied by bronchial hyperreactivity that may augment the symptoms of dyspnea in patients with CHF and MVS.

Section snippets

Study Population

A total of 30 patients underwent complete cardiac catheterization, including biplanar ventriculography, selective coronary angiography, and hemodynamic measurement using standard procedures. Twenty-one patients (3 female, 18 male; age range, 47 to 69 years; mean, 56.2 years) with impaired left ventricular fonction either to secondary coronary artery disease (17 patients) or to dilated cardiomyopathy (4 patients) were included in this study. All patients were in New York Heart Association (NYHA)

RESULTS

The CHF and the control group showed no significant differences in age, body surface, baseline pulmonary function, and former smoking habits. The MVS group had a significant lower body surface, a different sex distribution, and fewer former smokers (Table 1).

There were no differences in right atrial and ventricular pressure in all groups. Mean arterial pulmonary pressure was elevated in the CHF and MVS group. The pulmonary wedge pressure was significantly augmented in the CHF group compared

REFERENCES (16)

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Manuscript received June 16; revision accepted September 15.

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