The alveolar to arterial oxygen partial pressure difference is associated with pulmonary diffusing capacity in heart failure patients

• 24% of the variance in pulmonary diffusing capacity is accounted for by AaDO2 normalized for global VO2 measured at rest.
• The lower the AaDO2 to VO2 ratio, the higher the DLCO.
• Normalizing the AaDO2 to VO2 ratio increases the association to DLCO.

In chronic heart failure (HF), the alveolar-capillary membrane undergoes a remodeling process that negatively affects gas exchange. In case of alveolar-capillary gas diffusion impairment, arterial desaturation (SaO2) is rarely observed in HF patients. At play are 3 factors: overall pulmonary diffusing capacity (assessed as lung diffusion for CO, DLCO), global O2 consumption (VO2) and alveolar (A) to arterial (a) pO2 gradient (AaDO2).In 100 consecutive stable HF patients, DLCO, resting respiratory gases and arterial blood gases were measured to determine VO2, paO2, pAO2 and AaDO2.DLCO was poorly but significantly related to AaDO2. The correlation improved after correcting AaDO2 for VO2 (p < 0.001, r = 0.49). Both VO2 and AaDO2 were independently associated with DLCO (p < 0.001). Patients with reduced DLCO showed no differences as regards paO2 and pAO2. AaDO2/VO2 showed a higher gradient in patients with lower DLCO.AaDO2 increase and VO2 reduction allow preventing low SaO2 in HF patients with reduced DLCO. Accordingly, we suggest considering AaDO2 and VO2 combined and reporting AaDO2/VO2.