Fixed maximal stroke index in patients after pneumonectomy

Patients who have undergone pneumonectomy (PNX) show limited exercise capacity, partly attributable to an impaired stroke index (SI). To determine whether this limitation is due to deconditioning, we assessed exercise performance and cardiopulmonary function in seven patients after PNX (age: 59 ± 2 yr, mean ± SEM) and eight normal, healthy nonsmokers (52 v 3 yr) before and after an ergometer exercise training program for 30 min per day, 5 d per week, for 8 wk at 65% of measured maximal O₂ uptake. Lung volume, diffusing capacity of carbon dioxide (DL_CO) and cardiac index (CI) were determined during steady-state exercise by a rebreathing method. Exercise endurance was measured at 80% of maximal power. As compared with normal subjects, patients who had had PNX showed diminished maximal oxygen uptake (V̇o_2max), as well as diminished lung volumes, ventilatory capacities, and maximal cardiac and stroke indexes. After training, V̇o_2max, endurance, and peripheral O₂ extraction improved in both groups. However, maximal cardiac and stroke indexes increased only in normal subjects and not in patients. We conclude that an irreversibly fixed maximal SI is a major source of exercise limitation after PNX, probably because of pulmonary arterial hypertension and/or mechanical distortion of the cardiac fossa. Ventilatory impairment after PNX did not prevent a training-induced increase in V̇o_2max. Exercise training confers significant functional benefit on postpneu-monectomy patients by enhancing peripheral O₂ extraction.