Pulmonary diffusion capacity as prognostic marker in chronic heart failure

In patients with chronic heart failure (CHF), alveolar-capillary membrane dysfunction may contribute to symptom exacerbation and exercise intolerance and may be an independent prognostic factor of clinical course. When the bloodgas barrier is challenged in the long term, as it is the case in CHF patients, vascular remodeling takes place in the lungs and acquires pathophysiologic and clinical relevance. In clinical practice, alveolar gas diffusion capacity may be explored by means of the single breath technique. Angiotensin-converting enzyme inhibitors ameliorate the alveolar membrane gas conductance abnormality and attenuate the remodeling. A better understanding of the mechanisms involved in alveolarcapillary membrane remodeling and the consequent development of new therapeutic strategies will clarify a pathophysiologic role of pulmonary ventilation and diffusion capacity in CHF syndrome.