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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The alterations in lung function caused by heart failure were first described some decades ago&#46; The advent of new tools for the diagnosis and investigation of heart disease&#44; such as echocardiography&#44; has subsequently made it possible to classify cardiac dysfunction with greater precision&#46; The objective of this study was to analyze and compare a series of lung function and gas exchange variables in patients who had been classified into 4 groups according to type of heart disease as diagnosed by echocardiography&#46;</p> <span class="elsevierStyleSectionTitle">Materials and Method</span><p class="elsevierStyleSimplePara elsevierViewall">Emergency room patients whose main symptom was acute dyspnea caused by cardiac or respiratory disease were included in the study&#46; The final sample comprised 71 patients whose echocardiogram revealed cardiac dysfunction&#46; Spirometry was carried out and resting arterial blood gases measured in this group&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Of the 71 patients with cardiopathy&#44; 31 had systolic dysfunction&#44; 27 diastolic dysfunction&#44; 7 cor pulmonale&#44; and 6 primary valve disease&#46; Spirometry revealed a generally obstructive pattern&#44; more marked in the group with cor pulmonale&#46; Analysis of arterial blood gases revealed slight hypoxemia with normocapnia in all groups&#44; but this was more accentuated in the patients with cor pulmonale and diastolic dysfunction&#46; An analysis of the correlations &#40;Pearson&#39;s r&#41; between cardiac and pulmonary variables revealed the statistically significant associations between cardiac mass and other variables to be as follows&#58; forced vital capacity r&#61;0&#46;34 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#44; forced expiratory volume in one second r&#61;0&#46;526 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;0001&#41;&#44; forced expiratory volume in one second as a percentage of predicted r&#61;0&#46;3 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;037&#41;&#44; and forced midexpiratory flow rate r&#61;0&#46;31 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#46; The correlation between left ventricular ejection fraction and PaO<span class="elsevierStyleInf">2</span> was r&#61;-0&#46;312 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;01&#41;&#59; the correlation between left ventricular end-diastolic diameter and PaO<span class="elsevierStyleInf">2</span> was r&#61;0&#46;369 &#40;p&#61;&#46;006&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In patients with cardiac dysfunction&#44; spirometry reveals a generally obstructive pattern&#44; which is more accentuated in patients with right ventricular dysfunction owing to the existence of prior lung disease&#46; The associations found between the cardiac and lung function variables do not help the physician to determine the predominant diagnosis for a patient more precisely or to establish a prognosis&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Las modificaciones de la funci&#243;n pulmonar producidas por la insuficiencia card&#237;aca se describieron hace ya varias d&#233;cadas&#46; La incorporaci&#243;n de nuevos ins-trumentos de diagn&#243;stico y valoraci&#243;n&#44; como la ecocardio-graf&#237;a&#44; ha permitido una mejor clasificaci&#243;n de la disfunci&#243;n card&#237;aca&#46; El objetivo de este estudio fue analizar y comparar diversas variables de funci&#243;n pulmonar y del intercambio de gases en 4 grupos de pacientes&#44; clasificados en funci&#243;n de la patolog&#237;a card&#237;aca diagnosticada por eco-cardiograf&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; en el estudio a pacientes que acudieron a urgencias por disnea aguda&#44; de origen car-d&#237;aco o respiratorio&#44; como principal s&#237;ntoma&#46; La muestra final estuvo compuesta por 71 individuos con disfunci&#243;n card&#237;aca evidenciada mediante ecocardiograf&#237;a&#44; a los que se realizaron una espirometr&#237;a y la determinaci&#243;n de gases ar-teriales en reposo&#46; Los datos se expresan como media y des-viaci&#243;n est&#225;ndar&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">De los 71 pacientes con cardiopat&#237;a&#44; 31 mos-traron disfunci&#243;n sist&#243;lica&#44; 27 diast&#243;lica&#44; 7 <span class="elsevierStyleItalic">cor pulmonale</span> y 6 patolog&#237;a valvular primaria&#46; La espirometr&#237;a mostr&#243; un patr&#243;n globalmente obstructivo&#44; m&#225;s marcado en el grupo con <span class="elsevierStyleItalic">cor pulmonale&#46;</span> El an&#225;lisis de los gases en sangre eviden-ci&#243; una ligera hipoxemia con normocapnia en todos los grupos&#44; pero m&#225;s acentuada en los grupos de <span class="elsevierStyleItalic">cor pulmonale</span> y disfunci&#243;n diast&#243;lica&#46; La correlaci&#243;n entre variables card&#237;a-cas y respiratorias mostr&#243; asociaci&#243;n estad&#237;sticamente sig-nificativa entre la masa card&#237;aca y la capacidad vital forza-da &#40;r &#61; 0&#44;34&#59; p de Pearson &#61; 0&#44;02&#41;&#44; el volumen espirado en el primer segundo &#40;r &#61; 0&#44;526&#59; p &#61; 0&#44;0001&#41;&#44; en volumen espirado en el primer segundo en porcentaje del valor de referencia &#40;r &#61; 0&#44;3&#59; p &#61; 0&#44;037&#41; y el flujo mesoespiratorio forzado &#40;r &#61; 0&#44;31&#59; p &#61; 0&#44;03&#41;&#46; Tambi&#233;n mostraron correlaci&#243;n la fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo y la presi&#243;n arterial de O<span class="elsevierStyleInf">2</span> &#40;r &#61; -0&#44;312&#59; p &#61; 0&#44;01&#41;&#44; as&#237; como el di&#225;metro tele-diast&#243;lico del ventr&#237;culo izquierdo y la presi&#243;n arterial de O<span class="elsevierStyleInf">2</span> &#40;r &#61; 0&#44;369&#59; p &#61; 0&#44;006&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">La espirometr&#237;a de pacientes con disfunci&#243;n card&#237;aca muestra globalmente un patr&#243;n obstructivo&#44; m&#225;s acentuado en pacientes con disfunci&#243;n ventricular de-recha al existir patolog&#237;a pulmonar previa&#46; Las asociacio-nes halladas entre variables de funci&#243;n card&#237;aca y pulmonar no permiten valorar de una forma m&#225;s precisa la patolog&#237;a predominante en cada paciente ni establecer un pron&#243;stico&#46;</p>"
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Vol. 40. Issue 2.
Pages 62-66 (February 2004)
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Vol. 40. Issue 2.
Pages 62-66 (February 2004)
Original Articles
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Lung Function in Cardiac Dysfunction
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S. Ricarta, P. Casana,
Corresponding author
pcasan@hsp.santpau.es

Correspondence: Dr. P. Casan. Departamento de Neumología. Hospital de la Santa Creu i de Sant Pau. Sant Antoni Maria Claret, 167. 08025 Barcelona. España
, J. Bellido-Casadoa, M. Gonzáleza, C. Cotesb, L. Lópezb, J. Beldaa, A. Bayés-Ginésb
a Departamento de Neumología, Hospital de la Santa Creu i de Sant Pau, Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
b Departamento de Cardiología, Hospital de la Santa Creu i de Sant Pau, Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Objective

The alterations in lung function caused by heart failure were first described some decades ago. The advent of new tools for the diagnosis and investigation of heart disease, such as echocardiography, has subsequently made it possible to classify cardiac dysfunction with greater precision. The objective of this study was to analyze and compare a series of lung function and gas exchange variables in patients who had been classified into 4 groups according to type of heart disease as diagnosed by echocardiography.

Materials and Method

Emergency room patients whose main symptom was acute dyspnea caused by cardiac or respiratory disease were included in the study. The final sample comprised 71 patients whose echocardiogram revealed cardiac dysfunction. Spirometry was carried out and resting arterial blood gases measured in this group.

Results

Of the 71 patients with cardiopathy, 31 had systolic dysfunction, 27 diastolic dysfunction, 7 cor pulmonale, and 6 primary valve disease. Spirometry revealed a generally obstructive pattern, more marked in the group with cor pulmonale. Analysis of arterial blood gases revealed slight hypoxemia with normocapnia in all groups, but this was more accentuated in the patients with cor pulmonale and diastolic dysfunction. An analysis of the correlations (Pearson's r) between cardiac and pulmonary variables revealed the statistically significant associations between cardiac mass and other variables to be as follows: forced vital capacity r=0.34 (P=.02), forced expiratory volume in one second r=0.526 (P=.0001), forced expiratory volume in one second as a percentage of predicted r=0.3 (P=.037), and forced midexpiratory flow rate r=0.31 (P=.03). The correlation between left ventricular ejection fraction and PaO2 was r=-0.312 (P=.01); the correlation between left ventricular end-diastolic diameter and PaO2 was r=0.369 (p=.006).

Conclusions

In patients with cardiac dysfunction, spirometry reveals a generally obstructive pattern, which is more accentuated in patients with right ventricular dysfunction owing to the existence of prior lung disease. The associations found between the cardiac and lung function variables do not help the physician to determine the predominant diagnosis for a patient more precisely or to establish a prognosis.

Key words:
Heart failure
Spirometry
Arterial blood gasometry
Echocardiography
Objetivo

Las modificaciones de la función pulmonar producidas por la insuficiencia cardíaca se describieron hace ya varias décadas. La incorporación de nuevos ins-trumentos de diagnóstico y valoración, como la ecocardio-grafía, ha permitido una mejor clasificación de la disfunción cardíaca. El objetivo de este estudio fue analizar y comparar diversas variables de función pulmonar y del intercambio de gases en 4 grupos de pacientes, clasificados en función de la patología cardíaca diagnosticada por eco-cardiografía.

Material y método

Se incluyó en el estudio a pacientes que acudieron a urgencias por disnea aguda, de origen car-díaco o respiratorio, como principal síntoma. La muestra final estuvo compuesta por 71 individuos con disfunción cardíaca evidenciada mediante ecocardiografía, a los que se realizaron una espirometría y la determinación de gases ar-teriales en reposo. Los datos se expresan como media y des-viación estándar.

Resultados

De los 71 pacientes con cardiopatía, 31 mos-traron disfunción sistólica, 27 diastólica, 7 cor pulmonale y 6 patología valvular primaria. La espirometría mostró un patrón globalmente obstructivo, más marcado en el grupo con cor pulmonale. El análisis de los gases en sangre eviden-ció una ligera hipoxemia con normocapnia en todos los grupos, pero más acentuada en los grupos de cor pulmonale y disfunción diastólica. La correlación entre variables cardía-cas y respiratorias mostró asociación estadísticamente sig-nificativa entre la masa cardíaca y la capacidad vital forza-da (r = 0,34; p de Pearson = 0,02), el volumen espirado en el primer segundo (r = 0,526; p = 0,0001), en volumen espirado en el primer segundo en porcentaje del valor de referencia (r = 0,3; p = 0,037) y el flujo mesoespiratorio forzado (r = 0,31; p = 0,03). También mostraron correlación la fracción de eyección del ventrículo izquierdo y la presión arterial de O2 (r = -0,312; p = 0,01), así como el diámetro tele-diastólico del ventrículo izquierdo y la presión arterial de O2 (r = 0,369; p = 0,006).

Conclusions

La espirometría de pacientes con disfunción cardíaca muestra globalmente un patrón obstructivo, más acentuado en pacientes con disfunción ventricular de-recha al existir patología pulmonar previa. Las asociacio-nes halladas entre variables de función cardíaca y pulmonar no permiten valorar de una forma más precisa la patología predominante en cada paciente ni establecer un pronóstico.

Palabras clave:
Insuficiencia cardíaca
Espirometría
Gasometría arterial
Ecocardiografía
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This study was financed in part by Red Respira (RTIC-ISCIII-SEPAR).

Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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