Comprehensive Physiology Wiley Online Library

Gas Exchange Consequences of Left Heart Failure

Full Article on Wiley Online Library



Abstract

This review explores the pathophysiology of gas exchange abnormalities arising consequent to either acute or chronic elevation of pulmonary venous pressures. The initial experimental studies of acute pulmonary edema outlined the sequence of events from lymphatic congestion with edema fluid to frank alveolar flooding and its resultant hypoxemia. Clinical studies of acute heart failure (HF) suggested that hypoxemia was associated only with the final stage of alveolar flooding. However, in patients with chronic heart failure and normal oxygenation, hypoxemia could be produced by the administration of potent pulmonary vasodilators, suggesting that hypoxic pulmonary vasoconstriction is an important reflex for these patients. Patients with chronic left HF commonly manifest a reduced diffusing capacity, an abnormality that appears to be a consequence of chronic elevation of left atrial pressure. That reduction in diffusing capacity does not appear to be primarily attributable to increases in lung water but is improved by any sustained treatment that improves overall cardiac function. Patients with heart failure may also manifest an abnormally elevated during exercise, and that exercise ventilation abnormality arises as a consequence of both alveolar hyperventilation and elevated physiologic dead space. That elevated exercise in an HF patient has proven to be a powerful predictor of an adverse outcome and hence it has received sustained attention in the HF literature. At least three of the classes of drugs used to treat HF will normalize the exercise , suggesting that the excessive ventilation response may be linked to elevated sympathetic activity. © 2011 American Physiological Society. Compr Physiol 1:621‐634, 2011.

Comprehensive Physiology offers downloadable PowerPoint presentations of figures for non-profit, educational use, provided the content is not modified and full credit is given to the author and publication.

Download a PowerPoint presentation of all images


Figure 1. Figure 1.

Microscopic progression of cardiogenic edema (Figs. 1A through 1D) due to fluid accumulation in the lung. Modified from Staub et al. 84.

Figure 2. Figure 2.

Changes in arterial oxygenation and accumulation of extravascular lung water (EVLW) after the elevation of pulmonary capillary pressure (PCP) above the critical edema point (steps 4‐8) and return of PCP to control (steps 9‐11). Asterisks describe significant difference from step 1. Figure from Scillia et al. 80.

Figure 3. Figure 3.

Rate of fluid accumulation (Kf,c) in isolated lungs from normal dogs (open triangles) and dogs with heart failure (filled triangles) in response to elevations of pulmonary venous pressure (Pv). From Townsley et al. 89.

Figure 4. Figure 4.

Model data demonstrating how the solubility of a gas eliminated from blood in a model lung influences the physiologic (dashed lines) calculated for that gas with 20% anatomic dead space and three different degrees (j, k, and l) of heterogeneity. From Hlastala and Robertson 40.

Figure 5. Figure 5.

Response of (A) renal sympathetic nerve activity (RSNA) and (B) minute ventilation () in response to hypoxia in normal control rabbits (filled symbols) and rabbits with chronic heart failure (CHF) (open circles). Asterisks denote statistically significant increases. From Sun et al. 87.



Figure 1.

Microscopic progression of cardiogenic edema (Figs. 1A through 1D) due to fluid accumulation in the lung. Modified from Staub et al. 84.



Figure 2.

Changes in arterial oxygenation and accumulation of extravascular lung water (EVLW) after the elevation of pulmonary capillary pressure (PCP) above the critical edema point (steps 4‐8) and return of PCP to control (steps 9‐11). Asterisks describe significant difference from step 1. Figure from Scillia et al. 80.



Figure 3.

Rate of fluid accumulation (Kf,c) in isolated lungs from normal dogs (open triangles) and dogs with heart failure (filled triangles) in response to elevations of pulmonary venous pressure (Pv). From Townsley et al. 89.



Figure 4.

Model data demonstrating how the solubility of a gas eliminated from blood in a model lung influences the physiologic (dashed lines) calculated for that gas with 20% anatomic dead space and three different degrees (j, k, and l) of heterogeneity. From Hlastala and Robertson 40.



Figure 5.

Response of (A) renal sympathetic nerve activity (RSNA) and (B) minute ventilation () in response to hypoxia in normal control rabbits (filled symbols) and rabbits with chronic heart failure (CHF) (open circles). Asterisks denote statistically significant increases. From Sun et al. 87.

References
 1. Adnot S, Radermacher P, Andrivet P, Dubois‐Rande JL, Dupeyrat A, Lemaire F. Effects of sodium‐nitroprusside and urapidil on gas exchange and ventilation‐perfusion relationships in patients with congestive heart failure. Eur Respir J 4: 69‐75, 1991.
 2. Agostoni P, Bussotti M, Cattadori G, Margutti E, Contini M, Muratori M, Marenzi G, Fiorentini C. Gas diffusion and alveolar‐capillary unit in chronic heart failure. Eur Heart J 27: 2538‐2543, 2006.
 3. Agostoni P, Cattadori G, Bianchi M, Wasserman K. Exercise‐induced pulmonary edema in heart failure. Circulation 108: 2666‐2671, 2003.
 4. Agostoni P, Contini M, Cattadori G, Apostolo A, Sciomer S, Bussotti M, Palermo P, Fiorentini C. Lung function with carvedilol and bisoprolol in chronic heart failure: Is beta selectivity relevant? Eur J Heart Fail 9: 827‐833, 2007.
 5. Agostoni P, Magini A, Andreini D, Contini M, Apostolo A, Bussotti M, Cattadori G, Palermo P. Spironolactone improves lung diffusion in chronic heart failure. Eur Heart J 26: 159‐164, 2005.
 6. Agostoni PG, Guazzi M, Bussotti M, Grazi M, Palermo P, Marenzi G. Lack of improvement of lung diffusing capacity following fluid withdrawal by ultrafiltration in chronic heart failure. J Am Coll Cardiol 36: 1600‐1604, 2000.
 7. Agostoni PG, Wasserman K, Perego GB, Guazzi M, Cattadori G, Palermo P, Lauri G, Marenzi G. Non‐invasive measurement of stroke volume during exercise in heart failure patients. Clin Sci (Lond) 98: 545‐551, 2000.
 8. Al‐Rawas OA, Carter R, Richens D, Stevenson RD, Naik SK, Tweddel A, Wheatley DJ. Ventilatory and gas exchange abnormalities on exercise in chronic heart failure. Eur Respir J 8: 2022‐2028, 1995.
 9. Anthonisen NR, Smith HJ. Respiratory acidosis as a consequence of pulmonary edema. Ann Intern Med 62: 991‐999, 1965.
 10. Arai TJ, Henderson AC, Dubowitz DJ, Levin DL, Friedman PJ, Buxton RB, Prisk GK, Hopkins SR. Hypoxic pulmonary vasoconstriction does not contribute to pulmonary blood flow heterogeneity in normoxia in normal supine humans. J Appl Physiol 106: 1057‐1064, 2009.
 11. Arruda AL, Pellikka PA, Olson TP, Johnson BD. Exercise capacity, breathing pattern, and gas exchange during exercise for patients with isolated diastolic dysfunction. J Am Soc Echocardiogr 20: 838‐846, 2007.
 12. Avery WG, Samet P, Sackner MA. The acidosis of pulmonary edema. Am J Med 48: 320‐324, 1970.
 13. Bencowitz HZ, LeWinter MM, Wagner PD. Effect of sodium nitroprusside on ventilation‐perfusion mismatching in heart failure. J Am Coll Cardiol 4: 918‐922, 1984.
 14. Burgess JH. Pulmonary diffusing capacity in disorders of the pulmonary circulation. Circulation 49: 541‐550, 1974.
 15. Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, Meverden RA, Roger VL. Systolic and diastolic heart failure in the community. JAMA 296: 2209‐2216, 2006.
 16. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344: 873‐880, 2001.
 17. Chua TP, Clark AL, Amadi AA, Coats AJ. Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol 27: 650‐657, 1996.
 18. Chua TP, Harrington D, Ponikowski P, Webb‐Peploe K, Poole‐Wilson PA, Coats AJ. Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol 29: 147‐152, 1997.
 19. Chua TP, Ponikowski P, Harrington D, Anker SD, Webb‐Peploe K, Clark AL, Poole‐Wilson PA, Coats AJ. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol 29: 1585‐1590, 1997.
 20. Clark AL, Coats AJ. Usefulness of arterial blood gas estimations during exercise in patients with chronic heart failure. Br Heart J 71: 528‐530, 1994.
 21. Clark AL, Volterrani M, Swan JW, Coats AJ. Ventilation‐perfusion matching in chronic heart failure. Int J Cardiol 48: 259‐270, 1995.
 22. Coats AJ. Why ventilatory inefficiency matters in chronic heart failure. Eur Heart J 26: 426‐427, 2005.
 23. Coffey RL, Albert RK, Robertson HT. Mechanisms of physiological dead space response to PEEP after acute oleic acid lung injury. J Appl Physiol 55: 1550‐1557, 1983.
 24. De Pasquale CG, Arnolda LF, Doyle IR, Aylward PE, Chew DP, Bersten AD. Plasma surfactant protein‐B: A novel biomarker in chronic heart failure. Circulation 110: 1091‐1096, 2004.
 25. Esler M, Kaye D, Lambert G, Esler D, Jennings G. Adrenergic nervous system in heart failure. Am J Cardiol 80: 7L‐14L, 1997.
 26. Estenne M, Yernault JC. The mechanism of CO2 retention in cardiac pulmonary edema. Chest 86: 936‐938, 1984.
 27. Farney RJ, Morris AH, Gardner RM, Armstrong JD Jr. Rebreathing pulmonary capillary and tissue volume in normals after saline infusion. J Appl Physiol 43: 246‐253, 1977.
 28. Fillmore SJ, Guimaraes AC, Scheidt SS, Killip T III. Blood‐gas changes and pulmonary hemodynamics following acute myocardial infarction. Circulation 45: 583‐591, 1972.
 29. Fillmore SJ, Shapiro M, Killip T. Arterial oxygen tension in acute myocardial infarction. Serial analysis of clinical state and blood gas changes. Am Heart J 79: 620‐629, 1970.
 30. Fink LI, Wilson JR, Ferraro N. Exercise ventilation and pulmonary artery wedge pressure in chronic stable congestive heart failure. Am J Cardiol 57: 249‐253, 1986.
 31. Franciosa JA, Leddy CL, Wilen M, Schwartz DE. Relation between hemodynamic and ventilatory responses in determining exercise capacity in severe congestive heart failure. Am J Cardiol 53: 127‐134, 1984.
 32. Garg R, Yusuf S. Overview of randomized trials of angiotensin‐converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Group on ACE Inhibitor Trials Collaborative. JAMA 273: 1450‐1456, 1995.
 33. Guazzi M. Alveolar gas diffusion abnormalities in heart failure. J Card Fail 14: 695‐702, 2008.
 34. Guazzi M, Agostoni P. Angiotensin‐converting enzyme inhibition restores the diffusing capacity for carbon monoxide in patients with chronic heart failure by improving the molecular diffusion across the alveolar capillary membrane. Clin Sci (Lond) 96: 17‐22, 1999.
 35. Guazzi M, Agostoni P, Bussotti M, Guazzi MD. Impeded alveolar‐capillary gas transfer with saline infusion in heart failure. Hypertension 34: 1202‐1207, 1999.
 36. Guazzi M, Agostoni P, Matturri M, Pontone G, Guazzi MD. Pulmonary function, cardiac function, and exercise capacity in a follow‐up of patients with congestive heart failure treated with carvedilol. Am Heart J 138: 460‐467, 1999.
 37. Guazzi M, Marenzi G, Alimento M, Contini M, Agostoni P. Improvement of alveolar‐capillary membrane diffusing capacity with enalapril in chronic heart failure and counteracting effect of aspirin. Circulation 95: 1930‐1936, 1997.
 38. Guazzi M, Reina G, Tumminello G, Guazzi MD. Exercise ventilation inefficiency and cardiovascular mortality in heart failure: The critical independent prognostic value of the arterial CO2 partial pressure. Eur Heart J 26: 472‐480, 2005.
 39. Guyton AC, Lindsey AW. Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema. Circ Res 7: 649‐657, 1959.
 40. Hlastala MP, Robertson HT. Inert gas elimination characteristics of the normal and abnormal lung. J Appl Physiol 44: 258‐266, 1978.
 41. Hogg JC, Agarawal JB, Gardiner AJ, Palmer WH, Macklem PT. Distribution of airway resistance with developing pulmonary edema in dogs. J Appl Physiol 32: 20‐24, 1972.
 42. Hopkins SR, McKenzie DC, Schoene RB, Glenny RW, Robertson HT. Pulmonary gas exchange during exercise in athletes. I. Ventilation‐perfusion mismatch and diffusion limitation. J Appl Physiol 77: 912‐917, 1994.
 43. Hsia CC. Recruitment of lung diffusing capacity: Update of concept and application. Chest 122: 1774‐1783, 2002.
 44. Huang W, Kingsbury MP, Turner MA, Donnelly JL, Flores NA, Sheridan DJ. Capillary filtration is reduced in lungs adapted to chronic heart failure: Morphological and haemodynamic correlates. Cardiovasc Res 49: 207‐217, 2001.
 45. Iliff LD, Greene RE, Hughes JM. Effect of interstitial edema on distribution of ventilation and perfusion in isolated lung. J Appl Physiol 33: 462‐467, 1972.
 46. Jessup M, Brozena S. Heart failure. N Engl J Med 348: 2007‐2018, 2003.
 47. Johnson RL Jr. Gas exchange efficiency in congestive heart failure. Circulation 101: 2774‐2776, 2000.
 48. Johnson RL Jr. Gas exchange efficiency in congestive heart failure II. Circulation 103: 916‐918, 2001.
 49. Kay JM, Edwards FR. Ultrastructure of the alveolar‐capillary wall in mitral stenosis. J Pathol 111: 239‐245, 1973.
 50. Kleber FX, Vietzke G, Wernecke KD, Bauer U, Opitz C, Wensel R, Sperfeld A, Glaser S. Impairment of ventilatory efficiency in heart failure: Prognostic impact. Circulation 101: 2803‐2809, 2000.
 51. Laveneziana P, O'Donnell DE, Ofir D, Agostoni P, Padeletti L, Ricciardi G, Palange P, Duranti R, Scano G. Effect of biventricular pacing on ventilatory and perceptual responses to exercise in patients with stable chronic heart failure. J Appl Physiol 106: 1574‐1583, 2009.
 52. Liang CS, Stewart DK, LeJemtel TH, Kirlin PC, McIntyre KM, Robertson HT, Brown R, Moore AW, Wellington KL, Cahill L, et al. Characteristics of peak aerobic capacity in symptomatic and asymptomatic subjects with left ventricular dysfunction. The Studies of Left Ventricular Dysfunction (SOLVD) Investigators. Am J Cardiol 69: 1207‐1211, 1992.
 53. Light RW, George RB. Serial pulmonary function in patients with acute heart failure. Arch Intern Med 143: 429‐433, 1983.
 54. Magri D, Brioschi M, Banfi C, Schmid JP, Palermo P, Contini M, Apostolo A, Bussotti M, Tremoli E, Sciomer S, Cattadori G, Fiorentini C, Agostoni P. Circulating plasma surfactant protein type B as biological marker of alveolar‐capillary barrier damage in chronic heart failure. Circ Heart Fail 2: 175‐180, 2009.
 55. Matthay MA, Folkesson HG, Clerici C. Lung epithelial fluid transport and the resolution of pulmonary edema. Physiol Rev 82: 569‐600, 2002.
 56. Miller A, Chusid L, Samortin TG. Acute, reversible respiratory acidosis in cardiogenic pulmonary edema. JAMA 216: 1315‐1319, 1971.
 57. Montaner JS, Tsang J, Evans KG, Mullen JB, Burns AR, Walker DC, Wiggs B, Hogg JC. Alveolar epithelial damage. A critical difference between high pressure and oleic acid‐induced low pressure pulmonary edema. J Clin Invest 77: 1786‐1796, 1986.
 58. Muir AL, Flenley DC, Kirby BJ, Sudlow MF, Guyatt AR, Brash HM. Cardiorespiratory effects of rapid saline infusion in normal man. J Appl Physiol 38: 786‐775, 1975.
 59. Mutlu GM, Koch WJ, Factor P. Alveolar epithelial beta 2‐adrenergic receptors: Their role in regulation of alveolar active sodium transport. Am J Respir Crit Care Med 170: 1270‐1275, 2004.
 60. Myers J, Salleh A, Buchanan N, Smith D, Neutel J, Bowes E, Froelicher VF. Ventilatory mechanisms of exercise intolerance in chronic heart failure. Am Heart J 124: 710‐719, 1992.
 61. Naum CC, Sciurba FC, Rogers RM. Pulmonary function abnormalities in chronic severe cardiomyopathy preceding cardiac transplantation. Am Rev Respir Dis 145: 1334‐1338, 1992.
 62. Noble WH, Kay JC, Obdrzalek J. Lung mechanics in hypervolemic pulmonary edema. J Appl Physiol 38: 681‐687, 1975.
 63. Olson LJ, Snyder EM, Beck KC, Johnson BD. Reduced rate of alveolar‐capillary recruitment and fall of pulmonary diffusing capacity during exercise in patients with heart failure. J Card Fail 12: 299‐306, 2006.
 64. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355: 251‐259, 2006.
 65. Pellegrino R, Dellaca R, Macklem PT, Aliverti A, Bertini S, Lotti P, Agostoni P, Locatelli A, Brusasco V. Effects of rapid saline infusion on lung mechanics and airway responsiveness in humans. J Appl Physiol 95: 728‐734, 2003.
 66. Piiper J, Scheid P. Comparison of diffusion and perfusion limitations in alveolar gas exchange. Respir Physiol 51: 287‐290, 1983.
 67. Ponikowski P, Chua TP, Anker SD, Francis DP, Doehner W, Banasiak W, Poole‐Wilson PA, Piepoli MF, Coats AJ. Peripheral chemoreceptor hypersensitivity: An ominous sign in patients with chronic heart failure. Circulation 104: 544‐549, 2001.
 68. Ponikowski P, Francis DP, Piepoli MF, Davies LC, Chua TP, Davos CH, Florea V, Banasiak W, Poole‐Wilson PA, Coats AJ, Anker SD. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: Marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation 103: 967‐972, 2001.
 69. Prisk GK, Olfert IM, Arai TJ, Wagner PD, Hopkins SR. Rapid intravenous infusion of 20 ml/kg saline does not impair resting pulmonary gas exchange in the healthy human lung. J Appl Physiol 108 (1): 53‐59, 2010.
 70. Puri S, Baker BL, Dutka DP, Oakley CM, Hughes JM, Cleland JG. Reduced alveolar‐capillary membrane diffusing capacity in chronic heart failure. pathophysiological relevance and relationship to exercise performance Its. Circulation 91: 2769‐2774, 1995.
 71. Puri S, Baker BL, Oakley CM, Hughes JM, Cleland JG. Increased alveolar/capillary membrane resistance to gas transfer in patients with chronic heart failure. Br Heart J 72: 140‐144, 1994.
 72. Puri S, Dutka DP, Baker BL, Hughes JM, Cleland JG. Acute saline infusion reduces alveolar‐capillary membrane conductance and increases airflow obstruction in patients with left ventricular dysfunction. Circulation 99: 1190‐1196, 1999.
 73. Rhodes KM, Evemy K, Nariman S, Gibson GJ. Relation between severity of mitral valve disease and results of routine lung function tests in non‐smokers. Thorax 37: 751‐755, 1982.
 74. Ries AL, Gregoratos G, Friedman PJ, Clausen JL. Pulmonary function tests in the detection of left heart failure: Correlation with pulmonary artery wedge pressure. Respiration 49: 241‐250, 1986.
 75. Robbins M, Francis G, Pashkow FJ, Snader CE, Hoercher K, Young JB, Lauer MS. Ventilatory and heart rate responses to exercise: Better predictors of heart failure mortality than peak oxygen consumption. Circulation 100: 2411‐2417, 1999.
 76. Robertson HT, Hlastala MP. Elevated alveolar Pco2 relative to predicted values during normal gas exchange. J Appl Physiol 43: 357‐364, 1977.
 77. Robertson HT, Pellegrino R, Pini D, Oreglia J, DeVita S, Brusasco V, Agostoni P. Exercise response after rapid intravenous infusion of saline in healthy humans. J Appl Physiol 97: 697‐703, 2004.
 78. Roughton FJ, Forster RE. Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. J Appl Physiol 11: 290‐302, 1957.
 79. Schultz HD, Li YL. Carotid body function in heart failure. Respir Physiol Neurobiol 157: 171‐185, 2007.
 80. Scillia P, Delcroix M, Lejeune P, Melot C, Struyven J, Naeije R, Gevenois PA. Hydrostatic pulmonary edema: Evaluation with thin‐section CT in dogs. Radiology 211: 161‐168, 1999.
 81. Siegel JL, Miller A, Brown LK, DeLuca A, Teirstein AS. Pulmonary diffusing capacity in left ventricular dysfunction. Chest 98: 550‐553, 1990.
 82. Snyder EM, Beck KC, Turner ST, Hoffman EA, Joyner MJ, Johnson BD. Genetic variation of the beta2‐adrenergic receptor is associated with differences in lung fluid accumulation in humans. J Appl Physiol 102: 2172‐2178, 2007.
 83. Staub NC. Pulmonary edema. Physiol Rev 54: 678‐811, 1974.
 84. Staub NC, Nagano H, Pearce ML. Pulmonary edema in dogs, especially the sequence of fluid accumulation in lungs. J Appl Physiol 22: 227‐240, 1967.
 85. Stickland MK, Welsh RC, Haykowsky MJ, Petersen SR, Anderson WD, Taylor DA, Bouffard M, Jones RL. Effect of acute increases in pulmonary vascular pressures on exercise pulmonary gas exchange. J Appl Physiol 100: 1910‐1917, 2006.
 86. Sullivan MJ, Higginbotham MB, Cobb FR. Increased exercise ventilation in patients with chronic heart failure: Intact ventilatory control despite hemodynamic and pulmonary abnormalities. Circulation 77: 552‐559, 1988.
 87. Sun SY, Wang W, Zucker IH, Schultz HD. Enhanced peripheral chemoreflex function in conscious rabbits with pacing‐induced heart failure. J Appl Physiol 86: 1273‐1282, 1999.
 88. Timmers HJ, Wieling W, Karemaker JM, Lenders JW. Denervation of carotid baro‐ and chemoreceptors in humans. J Physiol 553: 3‐11, 2003.
 89. Townsley MI, Fu Z, Mathieu‐Costello O, West JB. Pulmonary microvascular permeability. Responses to high vascular pressure after induction of pacing‐induced heart failure in dogs. Circ Res 77: 317‐325, 1995.
 90. Tsang JY, Walker DC, Robertson HT. Lung water and alveolar flooding on gas exchange in two models of pulmonary edema. J Crit Care 3: 219‐224, 1988.
 91. Verghese GM, Ware LB, Matthay BA, Matthay MA. Alveolar epithelial fluid transport and the resolution of clinically severe hydrostatic pulmonary edema. J Appl Physiol 87: 1301‐1312, 1999.
 92. Wagner PD, Gale GE, Moon RE, Torre‐Bueno JR, Stolp BW, Saltzman HA. Pulmonary gas exchange in humans exercising at sea level and simulated altitude. J Appl Physiol 61: 260‐270, 1986.
 93. Wasserman K, Zhang YY, Gitt A, Belardinelli R, Koike A, Lubarsky L, Agostoni PG. Lung function and exercise gas exchange in chronic heart failure. Circulation 96: 2221‐2227, 1997.
 94. Wensel R, Georgiadou P, Francis DP, Bayne S, Scott AC, Genth‐Zotz S, Anker SD, Coats AJ, Piepoli MF. Differential contribution of dead space ventilation and low arterial Pco2 to exercise hyperpnea in patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 93: 318‐323, 2004.
 95. West JB. Ventilation‐perfusion inequality and overall gas exchange in computer models of the lung. Respir Physiol 7: 88‐110, 1969.
 96. West JB. Thoughts on the pulmonary blood‐gas barrier. Am J Physiol Lung Cell Mol Physiol 285: L501‐513, 2003.
 97. Wilson JR, Ferraro N. Exercise intolerance in patients with chronic left heart failure: Relation to oxygen transport and ventilatory abnormalities. Am J Cardiol 51: 1358‐1363, 1983.

Contact Editor

Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite

H. Thomas Robertson. Gas Exchange Consequences of Left Heart Failure. Compr Physiol 2011, 1: 621-634. doi: 10.1002/cphy.c100010