RESUMO
Blood flow through intrapulmonary arteriovenous anastomoses (QÌIPAVA) increases in healthy humans breathing hypoxic gas and is potentially dependent on body position. Previous work in subjects breathing room air has shown an effect of body position when QÌIPAVA is detected with transthoracic saline contrast echocardiography (TTSCE). However, the potential effect of body position on QÌIPAVA has not been investigated when subjects are breathing hypoxic gas or with a technique capable of quantifying QÌIPAVA. Thus the purpose of this study was to quantify the effect of body position on QÌIPAVA when breathing normoxic and hypoxic gas at rest. We studied QÌIPAVA with TTSCE and quantified QÌIPAVA with filtered technetium-99m-labeled macroaggregates of albumin (99mTc-MAA) in seven healthy men breathing normoxic and hypoxic (12% O2) gas at rest while supine and upright. On the basis of previous work using TTSCE, we hypothesized that the quantified QÌIPAVA would be greatest with hypoxia in the supine position. We found that QÌIPAVA quantified with 99mTc-MAA significantly increased while subjects breathed hypoxic gas in both supine and upright body positions (ΔQÌIPAVA = 0.7 ± 0.4 vs. 2.5 ± 1.1% of cardiac output, respectively). QÌIPAVA detected with TTSCE increased from normoxia in supine hypoxia but not in upright hypoxia (median hypoxia bubble score of 2 vs. 0, respectively). Surprisingly, QÌIPAVA magnitude was greatest in upright hypoxia, when QÌIPAVA was undetectable with TTSCE. These findings suggest that the relationship between TTSCE and 99mTc-MAA is more complex than previously appreciated, perhaps because of the different physical properties of bubbles and MAA in solution. NEW & NOTEWORTHY Using saline contrast bubbles and radiolabeled macroaggregrates (MAA), we detected and quantified, respectively, hypoxia-induced blood flow through intrapulmonary arteriovenous anastomoses (QÌIPAVA) in supine and upright body positions in healthy men. Upright hypoxia resulted in the largest magnitude of QÌIPAVA quantified with MAA but the lowest QÌIPAVA detected with saline contrast bubbles. These surprising results suggest that the differences in physical properties between saline contrast bubbles and MAA in blood may affect their behavior in vivo.
Assuntos
Anastomose Arteriovenosa/fisiopatologia , Hemodinâmica , Hipóxia/fisiopatologia , Posicionamento do Paciente , Adolescente , Adulto , Ecocardiografia , Humanos , Masculino , Postura Sentada , Decúbito Dorsal , Adulto JovemRESUMO
Several methods exist to study intrapulmonary arteriovenous anastomoses (IPAVA) in humans. Transthoracic saline contrast echocardiography (TTSCE), i.e., bubble scores, is minimally-invasive, but cannot be used to quantify the magnitude of blood flow through IPAVA (QIPAVA). Radiolabeled macroaggregates of albumin (99mTc-MAA) have been used to quantify QIPAVA in humans, but this requires injection of radioactive particles. Previous work has shown agreement between 99mTc-MAA and TTSCE, but this has not been tested simultaneously in the same group of subjects. Thus, the purpose of this study was to determine if there was a relationship between QIPAVA quantified with 99mTc-MAA and bubble scores obtained with TTSCE. To test this, we used 99mTc-MAA and TTSCE to quantify and detect QIPAVA at rest and during exercise in humans. QIPAVA significantly increased from rest to exercise using 99mTc-MAA and TTSCE and there was a moderately-strong, but significant relationship between methods. Our data suggest that high bubble scores generally correspond with large QIPAVA quantified with 99mTc-MAA during exercise.