Acute effects of increase in pulmonary vascular distending pressures on pulmonary blood volume and pulmonary extravascular fluid volume in man.

Abstract

The acute hemodynamic effects of supine leg exercise or atrial pacing were studied in 114 patients undergoing right and either transseptal (87 cases) or retrograde (27 cases) left heart catheterization. Seventy-one patients - 15 with coronary artery disease, 22 with aortic valve disease, and 34 with mitral valve disease - performed exercise on a bicylce ergometer. Forty-three patients, of whom 22 had coronary artery disease, nine aortic valve disease and 12 mitral valve disease, were studied during rapid atrial pacing. Cardiac index (CI), pulmonary artery mean (PAm), and left atrial mean (LAm) pressure, pulmonary blood volume (PBV) and pulmonary extravascular volume (PEV) were measured during the control state and during acute intervention. Both exercise and pacing resulted in significant elevations in PAm (range 37-65%) and LAm (range 36-43%) mean pressures in all patients. Cardiac index rose between 34 and 58% in the exercise groups, but did not change in those who were paced. During intervention both PBV and PEV increased significantly in all but the nine patients with aortic valve disease who were paced. Although volume increased occurred, they did not achieve the 5% significanc- level. For all patients the mean increment in PBV ranged between 37 and 123 ml/m2 over control, while PEV rose between 15 and 35 ml/m2. In each group the increases in PEV and PBV were proporationate, so that the ratio of PEV/PBV DID NOT CHANGE SIGNIFICANTLY BETWEEN THE CONTROL AND INTERVENTION STATES. Thus PEV and PBV increases occurred with elevations in pulmonary vascular pressures whether or not blood flow increased. Our data in patients with normal pulmonary vascular beds (i.e., coronary artery disease and aortic valve disease) strongly support the hypothesis that recruitment of vascular channels accounts for the acute changes in PEV and PBV and that the changes in PEV over a brief period of time do not necessarily reflect a "true" increase in extravascular lung water. Although pressures are higher in the lungs of patients with mitral valve disease, the data also suggest that recruitment is likely to be the mechanism for the observed proportionate increase in pulmonary extravascular volume and pulmonary blood volume.