Key result
The fraction of pulmonary vascular resistance from large and medium veins was significantly higher in patients with ARDS (27.5%) or CHF (27.5%) compared to COPD (13%) or normal lungs (13.5%) (P<0.01).
Why the study?
Does the contribution of large and medium pulmonary veins to total pulmonary vascular resistance differ among patients with various lung and heart diseases?
Observational (n=64)
Does the contribution of large and medium pulmonary veins to total pulmonary vascular resistance differ among patients with various lung and heart diseases?
Absolute Event Rate: 27.5% vs 13.5%
p-value: p=<0.01
Large and medium pulmonary veins contribute significantly more to total pulmonary vascular resistance in patients with ARDS and congestive heart failure compared to those with COPD or normal lungs.
May alter pulmonary hemodynamic interpretation in ARDS and CHF; leaves open targeted therapies pending prospective studies.
To evaluate the contribution of large and medium pulmonary veins to the total pulmonary vascular resistance in various human lung diseases, we compared in 64 patients the pulmonary arterial proximal wedge pressure (Ppw), obtained when the balloon of a 7F pulmonary artery catheter was inflated with 1.5 ml air, with the distal wedge pressure (Pdw), obtained after the tip of the catheter was advanced until wedged in a small artery without balloon inflation. Ppw, reflecting the pressure in a large pulmonary vein, approximates the left atrial pressure, whereas Pdw reflects the pressure in a smaller pulmonary vein. Pdw was greater than Ppw in all 64 patients. The Pdw-Ppw gradient was 1.1 +/- 0.5 mmHg in nine patients with normal lungs and was significantly higher in 13 patients with chronic congestive heart failure (3.8 +/- 0.8 mmHg, P less than 0.01) and in 22 patients with adult respiratory distress syndrome (3.8 +/- 0.8 mmHg; P less than 0.01), but not in 20 patients with chronic obstructive pulmonary disease (1.8 +/- 0.7 mmHg). The distribution of the pulmonary vascular resistance was clearly different among the four groups. The fraction of the total pulmonary vascular resistance attributable to large and medium pulmonary veins was significantly increased (P less than 0.01) in adult respiratory distress syndrome (27.5 +/- 12%) and cardiac patients (27.5 +/- 9%) compared with patients with chronic obstructive pulmonary disease (13 +/- 5%) and normal lungs (13.5 +/- 6%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Teboul et al. (1992) conducted an observational in Various lung diseases (n=64). Adult respiratory distress syndrome or chronic congestive heart failure vs. Normal lungs or chronic obstructive pulmonary disease was evaluated on Fraction of total pulmonary vascular resistance attributable to large and medium pulmonary veins (p=<0.01). The fraction of pulmonary vascular resistance from large and medium veins was significantly higher in patients with ARDS (27.5%) or CHF (27.5%) compared to COPD (13%) or normal lungs (13.5%) (P<0.01).
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