Use of Noninvasive Gas Exchange to Track Pulmonary Vascular Responses to Exercise in Heart Failure

We determined whether a non-invasive gas exchange based estimate of pulmonary vascular (PV) capacitance [PV(CAP) = stroke volume (SV) × pulmonary arterial pressure (Ppa)] (GX(CAP)) tracked the PV response to exercise in heart-failure (HF) patients. Pulmonary wedge pressure (Ppw), Ppa, PV resistance (PVR), and gas exchange were measured simultaneously during cycle exercise in 42 HF patients undergoing right-heart catheterization. During exercise, P(ET)CO(2) and V(E)/VCO(2) were related to each other (r = −0.93, P < 0.01) and similarly related to mean Ppa (mPpa) (r = −0.39 and 0.36; P < 0.05); P(ET)CO(2) was subsequently used as a metric of mPpa. Oxygen pulse (O(2) pulse) tracked the SV response to exercise (r = 0.91, P < 0.01). Thus, GX(CAP) was calculated as O(2) pulse × P(ET)CO(2). During exercise, invasively determined PV(CAP) and non-invasive GX(CAP) were related (r = 0.86, P < 0.01), and GX(CAP) correlated with mPpa and PVR (r = −0.46 and −0.54; P < 0.01). In conclusion, noninvasive gas exchange measures may represent a simple way to track the PV response to exercise in HF.