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Depts of Medicine of the 1 Toronto General and 2 Mount Sinai Hospitals/University Health Network, University of Toronto, Toronto, Ontario, Canada
CORRESPONDENCE: T.D. Bradley, NU 9-112 Toronto General Hospital/UHN, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Fax: 416 3404197
Keywords: arterial blood gas tensions, cardiopulmonary interactions, hypocapnia
Received: February 12, 2001
Accepted July 25, 2001
The present study was supported by grants from the Canadian Institutes of Health Research (MOP-11607) and from the Heart and Stroke Foundation of Ontario. G. Lorenzi-Filho was supported by research fellowships from Fundacao de Amparo a Pesquisa do Estado de Sao Paulo, Brazil and the Dept of Medicine of the University of Toronto. E.R. Azevedo held a research fellowship from Astra Zeneca/Heart and Stroke Foundation of Canada. T.D. Bradley is a Senior Scientist of the Canadian Institutes of Health Research.
Hypocapnia contributes to the genesis of Cheyne-Stokes respiration and central sleep apnoea in patients with congestive heart failure (CHF) and is associated with increased mortality. However, the cause of hypocapnia in patients with chronic stable CHF is unknown. Since pulmonary congestion can induce hyperventilation via stimulation of pulmonary vagal afferents, the present study tested the hypothesis that in patients with CHF (carbon dioxide tension in arterial blood (Pa,CO2)) is inversely related to pulmonary capillary wedge pressure (PCWP), and that alterations in PCWP would cause inverse changes in Pa,CO2.
In 11 CHF patients undergoing diagnostic cardiac catheterization, haemodynamic variables and arterial blood gas tensions were measured simultaneously at baseline. In three patients, these measurements were repeated after coronary angiographic dye infusion and nitroglycerine infusion.
At baseline, Pa,CO2 correlated inversely with PCWP (r=–0.80, p=0.003). In the three patients in whom multiple measurements were made, acute alterations in PCWP caused inversely proportional changes in Pa,CO2.
The present study concludes that in patients with congestive heart failure, pulmonary capillary wedge pressure is an important determinant of carbon dioxide tension in arterial blood. These findings imply that hypocapnia in patients with chronic stable congestive heart failure is a respiratory manifestation of elevated left ventricular filling pressures.
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