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Lack of sensitivity of measurements of ventilation fraction at rest and during exercise in detection of hemodynamically significant pulmonary vascular abnormalities in collagen vascular disease


, : Lack of sensitivity of measurements of ventilation fraction at rest and during exercise in detection of hemodynamically significant pulmonary vascular abnormalities in collagen vascular disease. American Review of Respiratory Disease 123(5): 508-512

Wasted ventilation fraction (VD/VT) normally declines substantially during excercise in persons without lung disease. Failure of VD/VT to decrease during exercise is one of the earliest abnormalities in patients with dyspnea caused by pulmonary vaso-occlusive disease, suggesting that measurements of VD/VT at rest and during exercise are useful in the diagnosis of pulmonary vascular disorders. Pulmonary hemodynamic and VD/VT responses to exercise were studied in 11 patients in the supine position with suspected pulmonary vascular involvement caused by progressive systemic sclerosis, systemic lupus erythematosus or recurrent pulmonary emboli, 10 of whom had dyspnea at rest and/or on exertion. In contrast to previous reports of no change or an increase in VD/VT during exercise in patients with pulmonary vascular disease, VD/VT decreased significantly during exercise in 8 of 9 patients in whom mean pulmonary artery pressures were abnormally elevated at rest and/or during exercise. Apparently, normal responses of VD/VT to exercise do not exclude hemodynamically significant pulmonary vaso-occlusive disease.

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