[Study of non-invasive hemodynamic parameters in pulmonary edema: hypoalbuminemia is a factor frequently associated with acute diastolic cardiac insufficiency].
METHODS
A critical diminution of the gradient between plasma oncotic pressure (PO) and pulmonary capillary pressure (PCP) is the origin of the formation of haemodynamic pulmonary oedema (OAP), but the respective contribution of these two haemodynamic forces as a function of the type of cardiac insufficiency is not known.


METHODS
74 cases of OAP were included (78 +/- 15 years old, 43 diastolic defined by an ejection fraction greater than 45%, and 31 systolic), and 33 control subjects. PO and PCP were calculated respectively from total protein and albumin serum levels, and from transthoracic echocardiography with the new Doppler indices using refilling flow propagation speed in colour TM or the study of pulmonary venous flow, at the start of treatment.


RESULTS
The gradient was very significantly diminished in those with diastolic and systolic cardiac insufficiency compared to the control group (p < 0.001), with no difference between the two types of OAP. An elevation of PCP > or = 18 mm Hg was the principal haemodynamic factor in the critical diminution of the gradient in the systolic group and in the diastolic group with ischaemic or valvular cardiopathy. In parallel with the elevation in PCP was a state of plasma hypo-oncocity < or = 18 mm Hg, consecutive with a significant diminution of albuminaemia, contributing to the critical diminution of the gradient in 41% of diastolic cases versus 3% of systolic cases.


CONCLUSIONS
Hypo-albuminaemia is a factor frequently favouring acute diastolic cardiac insufficiency in elderly subjects and must be sought systematically.
Arquès
S
S
Service de cardiologie, CH Aubagne, avenue des Soeurs-Gastine, 13400 Aubagne.
Ambrosi
P
P
Gélisse
R
R
Piéri
B
B
Aviérinos
J F
JF
Amichot
J L
JL
Luccioni
R
R
Habib
G
G
D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis / Q000503:physiopathology*