The determinants of exercise intolerance in heart failure (HF) are multifactorial. Moreover, the role of thoracic vascular imaging still remains scarce in its evaluation. For example, a reduction in lung cross-sectional area of vessels < 5 mm in diameter (%CSA<5) in smokers was associated with a reduction in six-minute walking distance.
1In addition, the relationship between the pulmonary artery and aortic diameters (PA/Ao ratio) becomes a promising marker related to exercise capacity in chronic obstructive pulmonary disease.
- Estépar RS
- Kinney GL
- Black-Shinn JL
- et al.
Computed tomographic measures of pulmonary vascular morphology in smokers and their clinical implications.
Am J Respir Crit Care Med. 2013; 188: 231-239https://doi.org/10.1164/rccm.201301-0162OC
2Of note, one study has shown a close relationship between PA/Ao ratio and %CSA<5 with hemodynamic variables regarded as crucial determinants of exercise capacity in pulmonary arterial hypertension (PAH).
- Chung KS
- Kim YS
- Kim SK
- et al.
Functional and prognostic implications of the main pulmonary artery diameter to aorta diameter ratio from chest computed tomography in Korean COPD patients.
PLoS One. 2016; 11e0154584https://doi.org/10.1371/journal.pone.0154584
3On the other hand, pulmonary vascular alterations with endothelial dysfunction would trigger other abnormalities, such as non-smoking-related emphysema by activation of apoptosis.
- Shimizu K
- Tsujino I
- Sato T
- et al.
Performance of computed tomography-derived pulmonary vasculature metrics in the diagnosis and haemodynamic assessment of pulmonary arterial hypertension.
Eur J Radiol. 2017; 96: 31-38https://doi.org/10.1016/j.ejrad.2017.09.010
4Accordingly, emphysema-like physiological abnormalities during exercise in HF, such as dynamic hyperinflation and ventilatory constraints,
- Giordano RJ
- Lahdenranta J
- Zhen L
- et al.
Targeted induction of lung endothelial cell apoptosis causes emphysema-like changes in the mouse.
J Biol Chem. 2008; 283: 29447-29460https://doi.org/10.1074/jbc.M804595200
5have not yet been addressed with detailed pulmonary imaging techniques in subjects without criteria for obstructive lung disease. Thus, this study aims to explore whether thoracic vascular imaging and emphysema metrics are related to metabolic, ventilatory and circulatory adjustments during incremental exercise, seeking to expand the monitoring capabilities of HF-associated vasculopathy and its consequences on physical activity.
- Smith JR
- Olson TP.
Ventilatory constraints influence physiological dead space in heart failure.
Exp Physiol. 2019; 104: 70-80https://doi.org/10.1113/EP087183
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- Computed tomographic measures of pulmonary vascular morphology in smokers and their clinical implications.Am J Respir Crit Care Med. 2013; 188: 231-239https://doi.org/10.1164/rccm.201301-0162OC
- Functional and prognostic implications of the main pulmonary artery diameter to aorta diameter ratio from chest computed tomography in Korean COPD patients.PLoS One. 2016; 11e0154584https://doi.org/10.1371/journal.pone.0154584
- Performance of computed tomography-derived pulmonary vasculature metrics in the diagnosis and haemodynamic assessment of pulmonary arterial hypertension.Eur J Radiol. 2017; 96: 31-38https://doi.org/10.1016/j.ejrad.2017.09.010
- Targeted induction of lung endothelial cell apoptosis causes emphysema-like changes in the mouse.J Biol Chem. 2008; 283: 29447-29460https://doi.org/10.1074/jbc.M804595200
- Ventilatory constraints influence physiological dead space in heart failure.Exp Physiol. 2019; 104: 70-80https://doi.org/10.1113/EP087183
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Published online: May 16, 2022
Accepted: May 11, 2022
Received: February 15, 2021
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.