title: Reduced pulmonary microvascular permeability in severe chronic left heart failure.
abstract: Pulmonary edema is a serious complication of heart failure, but often patients with chronic heart failure resist pulmonary edema despite elevated pulmonary venous pressures. This protection might be a result of decreased pulmonary microvascular permeability. Double-isotope scintigraphy with 113mindium-labeled transferrin and 99mtechnetium-labeled erythrocytes allows noninvasive estimation of pulmonary microvascular permeability; an index of transferrin accumulation is calculated that reflects microvascular permeability. Fourteen patients with severe chronic left ventricular dysfunction were compared with a control group of 15 patients with mild coronary artery disease. In the control group the transferrin accumulation index was 0.35 (range -0.3 to 1.0) x 10(-3)/min, and in patients with heart failure the index was 0.0 (range -1.0 to 0.7) x 10(-3)/min, which was significantly lower (p less than 0.01). The reduction in the transferrin accumulation index correlated weakly with the duration of heart failure (R = -0.5, p less than 0.02). These data indicate reduced protein efflux consistent with a decrease in pulmonary microvascular permeability in patients with severe chronic heart failure. Similar changes have been observed in severe mitral stenosis and may reflect a generalized adaptation to chronic pulmonary venous hypertension.
authors.affiliation: Cardiac Department, Royal Free Hospital, London, England.
authors.forename: S W
authors.initials: SW
authors.lastname: Davies
authors.forename: J
authors.initials: J
authors.lastname: Bailey
authors.forename: J
authors.initials: J
authors.lastname: Keegan
authors.forename: R
authors.initials: R
authors.lastname: Balcon
authors.forename: R M
authors.initials: RM
authors.lastname: Rudd
authors.forename: D P
authors.initials: DP
authors.lastname: Lipkin
mesh_terms: D000368:Aged; D002199:Capillary Permeability / Q000502:physiology*; D004912:Erythrocytes; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007205:Indium Radioisotopes; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D011877:Radionuclide Imaging; D013667:Technetium; D014168:Transferrin; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D007205:Indium Radioisotopes; D014168:Transferrin; D013667:Technetium