"Reduction in CO produces two opposing effect:
Reduction in CO
=> reduction in mixed venous O2 content
=> greater reduction in PaO2 (provided shunt fraction is the same)
Reduction in CO
=> reduction in the shunt fraction (except for atelectasis)
(maybe due to pulmonary vasoconstriction secondary to reduced PvO2)
Overall, the effect of reduced CO is
reduced shunt
more desaturated mixed venous blood
roughly unchanged PaO2, and thus A-a gradient"