{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:43:59Z","timestamp":1787503439962,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,8,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Hemodynamic perturbations in heart failure with preserved ejection fraction (HFpEF) may alter the distribution of blood in the lungs, impair gas transfer from the alveoli into the pulmonary capillaries, and reduce lung diffusing capacity. We hypothesized that impairments in lung diffusing capacity for carbon monoxide (DL\n                      <jats:sub>CO<\/jats:sub>\n                      ) in HFpEF would be associated with high mean pulmonary capillary wedge pressures during exercise.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Rebreathe DL\n                      <jats:sub>CO<\/jats:sub>\n                      and invasive hemodynamics were measured simultaneously during exercise in patients with exertional dyspnea. Pulmonary pressure waveforms and breath\u2010by\u2010breath pulmonary gas exchange were recorded at rest, 20 W, and symptom\u2010limited maximal exercise. Patients with HFpEF (n=20; 15 women, aged 65\u00b111\u00a0years, body mass index 36\u00b18\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) achieved a lower symptom\u2010limited maximal workload (52\u00b127\u00a0W versus 106\u00b142\u00a0W) compared with controls with noncardiac dyspnea (n=10; 7 women, aged 55\u00b110\u00a0years, body mass index 30\u00b15 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). DL\n                      <jats:sub>CO<\/jats:sub>\n                      was lower in patients with HFpEF compared with controls at rest (DL\n                      <jats:sub>CO<\/jats:sub>\n                      10.4\u00b12.9\u00a0mL\/min per mm\u00a0Hg versus 16.4\u00b16.9\u00a0mL\/min per mm\u00a0Hg,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01) and symptom\u2010limited maximal exercise (DL\n                      <jats:sub>CO<\/jats:sub>\n                      14.6\u00b14.7\u00a0mL\/min per mm\u00a0Hg versus 23.8\u00b110.8\u00a0mL\/min per mm\u00a0Hg,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01) because of a lower alveolar\u2010capillary membrane conductance in HFpEF (rest 16.8\u00b16.6\u00a0mL\/min per mm\u00a0Hg versus 28.4\u00b111.8\u00a0mL\/min per mm\u00a0Hg,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01; symptom\u2010limited maximal exercise 25.0\u00b16.7\u00a0mL\/min per mm\u00a0Hg versus 45.5\u00b122.2\u00a0mL\/min per mm\u00a0Hg,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01). DL\n                      <jats:sub>CO<\/jats:sub>\n                      was lower in HFpEF for a given mean pulmonary artery pressure, mean pulmonary capillary wedge pressure, pulmonary arterial compliance, and transpulmonary gradient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Lung diffusing capacity is lower at rest and during exercise in HFpEF due to impaired gas conductance across the alveolar\u2010capillary membrane. DL\n                      <jats:sub>CO<\/jats:sub>\n                      is impaired for a given pulmonary capillary wedge pressure and pulmonary arterial compliance. These data provide new insight into the complex relationships between hemodynamic perturbations and gas exchange abnormalities in HFpEF.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.120.019950","type":"journal-article","created":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T05:08:45Z","timestamp":1628312925000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Simultaneous Measurement of Lung Diffusing Capacity and Pulmonary Hemodynamics Reveals Exertional Alveolar\u2010Capillary Dysfunction in Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1027-7081","authenticated-orcid":false,"given":"Caitlin C.","family":"Fermoyle","sequence":"first","affiliation":[{"name":"Mayo Clinic Graduate School of Biomedical SciencesMayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5383-0479","authenticated-orcid":false,"given":"Glenn M.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9375-0596","authenticated-orcid":false,"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6283-783X","authenticated-orcid":false,"given":"Bruce D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz641"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hft026"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.913"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy268"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.03.003"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.11.051"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz713"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.03.001"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1960.15.5.893"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.2340\/1650197719702239298"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1590ST"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.4.1313"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01300.2006"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01411.2009"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.6.1850"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00962-2016"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2016.12.007"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2015.12.016"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031608"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-0619"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw241"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.cp120113"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00192.2020"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.00162.2004"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2012.234310"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.003011"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.13565"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.116.003612"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034905"}],"container-title":["Journal 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