Lung fluid clearance in chronic heart failure patients

Abstract Chronic elevation of pulmonary microvascular pressure (Pmv) consistently leads to alveolocapillary barrier thickening and reduction in the filtration coefficient. In animal models of chronic heart failure (CHF) the lung remains dry despite hydrostatic forces. As fluid flux is bi-directional...

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Bibliographic Details
Published in:International journal of cardiology 2017-10, Vol.244, p.245-247
Main Authors: Dixon, Dani-Louise, De Pasquale, Carmine G, Lawrence, Mark D, Cavallaro, Elena, Rubino, Vito, Bersten, Andrew D
Format: Article
Language:English
Subjects:
Aerosol scintigraphy
Aged
Bronchoalveolar Lavage Fluid
Cardiovascular
Catecholamines
Chronic Disease
Chronic heart failure
Cohort Studies
Female
Heart Failure - diagnostic imaging
Heart Failure - metabolism
Humans
Lung - diagnostic imaging
Lung - metabolism
Male
Middle Aged
Organotechnetium Compounds - metabolism
Pentetic Acid - metabolism
Pulmonary Edema - diagnostic imaging
Pulmonary Edema - metabolism
Pulmonary fluid clearance
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Summary:Abstract Chronic elevation of pulmonary microvascular pressure (Pmv) consistently leads to alveolocapillary barrier thickening and reduction in the filtration coefficient. In animal models of chronic heart failure (CHF) the lung remains dry despite hydrostatic forces. As fluid flux is bi-directional, it has been postulated that an increase in alveolar fluid clearance may facilitate the dry lung when Pmv is chronically elevated. In this study we aimed to examine alveolar fluid clearance in ambulatory patients with CHF secondary to left ventricular (LV) systolic dysfunction compared against non-CHF controls. Lung clearance following aerosol delivery of99m technetium (Tc)-diethyl triaminepentaacetic acid (DTPA) was measured non-invasively by scintigraphy and half time of99m Tc-DTPA clearance (T (1/2)) was calculated by mono-exponential curve fit. Alveolar fluid clearance measured as half time DTPA clearance was significantly faster in CHF patients than controls ( P = 0.001). This was further defined by NYHA classification. No correlation was found between DTPA clearance and plasma epinephrine, norepinephrine or aldosterone hormone ( P > 0.05). Our results support an association between increasing alveolar fluid clearance and disease severity in CHF, and the concept of controlled bi-directional fluid flux in CHF associated with increasing Pmv, and represents another defence mechanism of the lung against pulmonary oedema.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2017.05.096