[Usefulness in clinical practice of noninvasive measurement of colloids osmotic pressure-capillary pulmonary pressure gradient in the management of acute dyspnea].
BACKGROUND
Increased pulmonary capillary pressure (PAWP) and decreased serum colloid osmotic pressure (COP) are important factors in pulmonary edema (PE) formation. The aim of this study was to evaluate the clinical usefulness of noninvasive determination of COP, PAWP and COP-PAWP gradient in patients with acute dyspnea.


METHODS
Thirty four patients presenting with PE, 19 with preserved left ventricular systolic function (Ia) and 15 with depressed systolic function (Ib), and 26 patients presenting with acute pulmonary diseases (II) were enrolled. COP was estimated using Landis and Pappenheimer formula (COP = 2.1 x P + 0.16 x P2 + 0.009 x P3, P: serum total protein concentration). PAWP was measured by transthoracic Doppler echocardiography using E/Vp and 1000/(2 x IPT + Vp) Doppler indexes.


RESULTS
The mean value of the gradient was 0.5 +/- 5, 1.7 +/- 3.4 and 10.4 +/- 4.7 mmHg in Ia, Ib and II respectively (P < 0.001 Ia and Ib vs II). PAWP was higher in Ia and Ib than in II (P < 0.001). However, hypoalbuminemia with COP < or = 18 mmHg was observed in 63% of patients in Ia as compared to those in Ib (7%) and II (8%).


CONCLUSIONS
Severe hypoalbuminemia frequently contributes to PE formation in the presence of normal left ventricular systolic function. A COP-PAWP gradient value lower than 6 mmHg is highly predictive of the diagnosis of acute heart failure in these patients presenting with acute dyspnea.
Arquès
S
S
Service de cardiologie, centre hospitalier Aubagne, avenue des Soeurs-Gastine, 13400 Aubagne, France. fx.arques@wanadoo.fr
Pieri
B
B
Gélisse
R
R
Gouvernet
J
J
Cheung
L Foo
LF
Amichot
J L
JL
Ambrosi
P
P
Habib
G
G
Luccioni
R
R
D000208:Acute Disease; D000368:Aged; D002196:Capillaries; D004417:Dyspnea / Q000175:diagnosis* / Q000473:pathology; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009997:Osmotic Pressure; D011237:Predictive Value of Tests; D011654:Pulmonary Edema / Q000150:complications* / Q000175:diagnosis; D012129:Respiratory Function Tests; D016277:Ventricular Function, Left