Document Detail


Alteration of the alveolar-capillary membrane diffusing capacity in chronic left heart disease.
MedLine Citation:
PMID:  9723633     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
During left heart disease, the chronic increase in pulmonary capillary wedge pressure (PCWP) results both in vascular alterations with increased pulmonary vascular resistance (PVR), and in progressive thickening of the alveolar-capillary membrane, which diffusing capacity (Dm) is reduced. However, the total lung diffusing capacity for carbon monoxide (TLco) is inconstantly impaired, depending on the degree of pulmonary congestion. We evaluated the relation between the pulmonary hemodynamic repercussions of chronic heart disease and the 2 components of TLco, i.e., Dm and capillary blood volume. Forty-seven patients with chronic left heart disease (28 with valve disease, 19 with cardiomyopathy) underwent right heart catheterization with determination of PCWP and PVR. Pulmonary function tests, including spirometry, determination of TLco, and of its 2 components (percentage of predicted values) were performed in patients and in 15 healthy subjects. TLco and Dm, but not capillary blood volume, were significantly decreased in patients. Dm was related to PVR (p = 0.0006), and was markedly reduced in patients with high PVR (> or = 3 Wood U): 54 +/- 8% vs 80 +/- 19% in patients with normal PVR (p <0.0001). Dm < or = 66% identified all high PVR patients (sensitivity = 100%, specificity = 77%). Capillary blood volume was related to PCWP (p = 0.02), and was increased in patients with high PCWP (> 15 mm Hg): 126 +/- 30% vs 99 +/- 23% (p <0.01), but with a marked overlap. TLco values, although reduced in patients with high PVR (p <0.001), were not predictive of high PVR or high PCWP. Determination of Dm allows a more accurate detection of pulmonary hypertension complicating chronic left heart disease than the other pulmonary parameters.
Authors:
P Assayag; H Benamer; P Aubry; C de Picciotto; E Brochet; S Besse; F Camus
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  82     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1998 Aug 
Date Detail:
Created Date:  1998-09-16     Completed Date:  1998-09-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  459-64     Citation Subset:  AIM; IM    
Affiliation:
Service de Cardiologie, Service d'Explorations Fonctionnelles, and INSERM U460, Hôpital Bichat-Claude Bernard, Faculté de Médecine Xavier Bichat (Université Paris VII), France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Heart Catheterization
Hemodynamics*
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Diffusing Capacity*
Pulmonary Heart Disease / physiopathology*
Pulmonary Wedge Pressure
Smoking / adverse effects
Spirometry
Vascular Resistance

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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