Chest
Volume 120, Issue 2, August 2001, Pages 467-473
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Clinical Investigations
Cardiology
Effect of Hyperoxia on Left Ventricular Function and Filling Pressures in Patients With and Without Congestive Heart Failure

https://doi.org/10.1378/chest.120.2.467Get rights and content

Study objectives

To determine the effects of hyperoxia on left ventricular (LV) function in humans with and without congestive heart failure (CHF).

Design

An acute physiologic study of the effect of hyperoxia on right-heart hemodynamics, LV contractility (peak positive rate of rise of LV pressure [+dP/dt]), time constant of isovolumic left ventricular relaxation (τ), and LV filling pressures.

Setting

Bayer Cardiovascular Clinical Research Laboratory at the Mount Sinai Hospital, Toronto, Ontario.

Patients

Sixteen patients with stable CHF and 12 subjects with normal LV function received the hyperoxia intervention.

Interventions

Patients received 21% O2 by a nonrebreather mask, followed by 100% O2 for 20 min, and 21% O2 for a 10-min recovery period.

Results

In response to hyperoxia, there was a 22 ± 6% increase in LV end-diastolic pressure (LVEDP) in the CHF group and a similar 29 ± 14% increase in LVEDP in the normal LV function group (p < 0.05 for both; mean ± SEM). Hyperoxia was also associated with a prolongation in τ of 10 ± 2% in the CHF group (p < 0.05) and 8 ± 2% in the normal LV function group (p < 0.05). No changes in +dP/dt were observed in either group.

Conclusions

Hyperoxia was associated with impairment of cardiac relaxation and increased LV filling pressures in patients with and without CHF. These observations indicate that caution should be used in the administration of high inspired O2 fractions to normoxic patients, especially in the setting of CHF.

Section snippets

Study Population

Thirty-five patients, separated into three groups, participated in this study. The CHF group (n = 16; mean age, 62 ± 2 years; 15 men and 1 woman) all had stable symptoms (New York Heart Association class II and III) and a LV ejection fraction by radionuclide ventriculography of < 35% (mean value, 25 ± 2%). This group included 5 patients with idiopathic dilated cardiomyopathy and 11 patients with coronary artery disease. Medical therapy in this group included diuretics (n = 14), digoxin (n = 7),

Baseline Characteristics

The CHF group had significantly elevated heart rate and filling pressures, as well as impaired LV contractility and relaxation, compared to the normal LV function group. Baseline arterial O2 saturation was similar in the two groups (Table 1).

The Effect of Hyperoxia on Hemodynamics, Blood Gases, and Lactate Levels

In the CHF group, the hyperoxia stimulus was associated with several hemodynamic changes, including an increase in SVR, and reductions in cardiac output, stroke volume, and coronary sinus blood flow (p < 0.05 for all; Table 2). In the normal LV function

Discussion

Our study confirmed that hyperoxia causes systemic vasoconstriction and reduces cardiac output. We have expanded these findings by demonstrating that hyperoxia is also associated with prolongation in the time constant of isovolumic LV relaxation, τ, and increases in LVEDP. Therefore, our observations suggest that hyperoxia is associated with disturbances of both early and late phases of LV filling. Furthermore, these effects were observed not only in patients with CHF, but also in subjects with

Acknowledgment

The authors thank the staff of the Bayer Cardiovascular Clinical Research Laboratory of the Mount Sinai Hospital, as well as Drs. John Floras and John Parker for review of the article.

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  • Cited by (0)

    Drs. Mak and Azevedo are Research Fellows of the Heart and Stroke Foundation, Dr. Liu holds the Heart and Stroke Polo Chair in Cardiovascular Research, and Dr. Newton is a Research Scholar of the Heart and Stroke Foundation of Canada.

    This work was supported by a Grant in Aid from the Heart and Stroke Foundation of Ontario (grant No. NA-3469), and by Bayer Canada, Inc.

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