| Impeded alveolar-capillary gas transfer with saline infusion in heart failure. | |
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MedLine Citation:
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PMID: 10601119 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The microvascular pulmonary endothelium barrier is critical in preventing interstitial fluid overflow and deterioration in gas diffusion. The role of endothelium in transporting small solutes in pathological conditions, such as congestive heart failure (CHF), has not been studied. Monitoring of pulmonary gas transfer during saline infusion in CHF was used to probe this issue. Carbon monoxide diffusion (DL(CO)), its membrane diffusion (D(M)) and capillary blood volume (V(C)) subcomponents, and mean right atrial (rap) and mean pulmonary wedge (wpp) pressures after saline or 5% D-glucose solution infusions were compared with baseline in 26 moderate CHF patients. Saline was also tested in 13 healthy controls. In patients, 750 mL of saline lowered DL(CO) (-8%, P<0.01 versus baseline), D(M) (-10%, P<0.01 versus baseline), aldosterone (-29%, P<0.01 versus baseline), renin (-52%, P<0.01 versus baseline), and hematocrit (-6%, P<0.05 versus baseline) and increased V(C) (20%, P<0.01 versus baseline), without changing rap and wpp. Saline at 150 mL produced qualitatively similar results regarding DL(CO) (-5%, P<0.01 versus baseline), D(M) (-7%, P<0.01 versus baseline), V(C) (9%, P<0.01 versus baseline), rap, wpp, aldosterone (-9%, P<0.05 versus baseline), and renin (-14%, P<0.05 versus baseline). Glucose solution (750 mL), on the contrary, increased DL(CO) (5%, P<0.01 versus 750 mL of saline) and D(M) (11%, P<0.01 versus 750 mL of saline) and decreased V(C) (-9, P<0.01 versus 750 mL of saline); aldosterone (-40%), renin (-41%), hematocrit (-3%), rap, and wpp behaved as they did after saline infusion. In controls, responses to both saline amounts were similar to responses in CHF patients regarding aldosterone, renin, hematocrit, rap, and wpp, whereas DL(CO), D(M), and V(C) values tended to rise. Hindrance to gas transfer (reduced DL(CO) and D(M)) with salt infusion in CHF, despite an increase in V(C) and no variations in pulmonary hydrostatic forces, indicates an upregulation in sodium transport from blood to interstitium with interstitial edema. Redistribution of blood from the lungs, facilitating interstitial fluid reabsorption, or sodium uptake from the alveolar lumen by the sodium-glucose cotransport system might underlie the improved alveolar-capillary conductance with glucose. |
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Authors:
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M Guazzi; P Agostoni; M Bussotti; M D Guazzi |
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Publication Detail:
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Type: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Hypertension Volume: 34 ISSN: 1524-4563 ISO Abbreviation: Hypertension Publication Date: 1999 Dec |
Date Detail:
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Created Date: 2000-01-19 Completed Date: 2000-01-19 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7906255 Medline TA: Hypertension Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1202-7 Citation Subset: IM |
Affiliation:
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Istituto di Cardiologia dell'Università degli Studi, Centro di Studio per le Ricerche Cardiovascolari del Consiglio Nazionale delle Ricerche, Fondazione "Monzino," I.R.C.C.S., Milano, Italy. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aldosterone
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blood,
secretion Blood Pressure / drug effects Blood Proteins / analysis Blood-Air Barrier / drug effects, physiology Capillaries / physiology* Carbon Monoxide / pharmacokinetics Glucose / administration & dosage Heart Failure / blood, physiopathology* Heart Function Tests / drug effects Hematocrit Hemoglobins / analysis Humans Infusions, Intravenous Male Middle Aged Pulmonary Alveoli / drug effects*, physiology Pulmonary Gas Exchange / drug effects*, physiology Renin / blood Respiratory Function Tests Sodium Chloride / administration & dosage* |
| Chemical | |
Reg. No./Substance:
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0/Blood Proteins; 0/Hemoglobins; 50-99-7/Glucose; 52-39-1/Aldosterone; 630-08-0/Carbon Monoxide; 7647-14-5/Sodium Chloride; EC 3.4.23.15/Renin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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