Effect of circulatory congestion on the components of pulmonary diffusing capacity in morbid obesity

Objective: Obese patients without clinically apparent heart disease may have a high output state and elevated total and central blood volumes. Central circulatory congestion should result in elevated pulmonary diffusing capacity (D_LCO) and capillary blood volume (V_c) reflecting pulmonary capillary recruitment; however, the effect on membrane diffusion (D_m) is uncertain. We examined D_LCO and its partition into V_c and D_m in 13 severely obese subjects (BMI = 51 ± 14 kg/m²) without manifest cardiopulmonary disease before and after surgically induced weight loss. Research Methods and Procedures: D_LCO and its partition into V_c and D_m referenced to alveolar volume (V_A)] as described by Roughton and Forster, total body water by tritiated water, and fat distribution by waist‐to‐hip ratio were performed. Results: Despite normal D_LCO (mean 98 ± 16% predicted), V_c/V_A was increased (mean 118 ± 30% predicted), and D_m/V_A was reduced (mean 77 ± 34% predicted). Nine of 13 subjects were restudied after weight loss (mean 52 ± 43 kg); V_c/V_A decreased to 89 ± 18% predicted (p = 0.01), and D_m/V_A increased to 139 ± 30% predicted (p < 0.01). Increasing total body water was associated with both increasing V_c (r = 0.74, p = 0.01) and increasing waist‐to‐hip ratio (r = 0.65, p = 0.02), indicating that circulatory congestion increases with increasing central obesity. Discussion: Severely obese subjects without manifest cardiopulmonary disease may have increased V_c indicating central circulatory congestion and reduced D_m suggesting associated alveolar capillary leak, despite normal D_LCO. Reversibility with weight loss is in accord with reversibility of the hemodynamic abnormalities of obesity.