Search

The prognosis of patients with idiopathic diffuse interstitial lung fibrosis is extremely variable and depends mainly on the presence and degree of pulmonary arterial hypertension. The incidence of pulmonary arterial hypertension in idiopathic diffuse interstitial lung fibrosis is not exactly known. We concluded from our study that in nonselected symptomatic patients about 50% have normal pulmonary arterial pressure and that advanced pulmonary arterial hypertension (over 30 mmHg) is present in about 10% of cases. The development of pulmonary arterial hypertension in idiopathic diffuse interstitial lung fibrosis, though generally slow, is very different in individual cases. We noted fast development of advanced pulmonary arterial hypertension within 2-3 years as well as stabilized normal pressure for 20 years or more. Further behaviour of pulmonary arterial pressure may not be safely predicted from any value in a first functional examination except in patients with initial advanced pulmonary arterial hypertension; they all either maintain or even increase their pulmonary arterial pressure and their 3-year mortality is over 50%. It is concluded that the knowledge of haemodynamic data not only improves our understanding of idiopathic diffuse interstitial lung fibrosis, but also enables us to determine the prognosis with a fair amount of accuracy.

The authors investigated the left ventricular systolic function and diastolic characteristic in 25 patients with mitral stenosis and compared the results with findings in 25 healthy subjects. The patients with mitral stenosis differed from the control group by elevated left ventricular filling pressure, greater left ventricular end-diastolic volume, reduced ejection fraction, and decreased calculated left ventricular compliance. Pathological values of these indicators, however, were infrequent and as a rule only slightly exceeded the normal limits. The decrease in left ventricular compliance had significant correlations with the degree of pulmonary arterial hypertension, elevation of right ventricular filling pressure, the ratio of filling pressures of both ventricles, and left ventricular end-systolic eccentricity. Consequently, the authors infer that the main factor decreasing the left ventricular compliance in mitral stenosis is the aberrant geometry of the ventricle. The authors also point out the correlations between the left ventricular systolic function and diastolic characteristics in mitral stenosis, and assume that this affection represents a complex, although not too advanced, disturbance of left ventricular function.

Duplex Doppler echocardiography with high pulse repetition frequency was used to study: group A - 7 patients with mitral stenosis (MS) during cardiac catheterization, and group B - 26 patients with MS in whom the Doppler examination was performed 24 h-3 months prior to catheterization. Using the peak flow velocity within the stenotic flow jet, the pressure drop and mitral valve area (MVA) were calculated and compared with data obtained invasively. The inter-observer variability of the two parameters was 12% and 5%, respectively. The correlation between Doppler pressure drop and invasive measurement was excellent in group A (r = 0.83), while less close in group B (r = 0.71). However, using only MVA estimates (group B), it was possible to recognize most of MS with catheterization MVA less than or equal to 1.0 cm2/m2 (sensitivity and predictive value both of 90%). Therefore, even nonsimultaneous quantitation of MS seems valuable in pre-operative patient evaluation, adding a new information to hitherto existing echocardiographic criteria.

The authors studied at repeated ventriculographic examinations the changes in the left ventricular function after application of routinely used ionic contrast medium and of newer nonionic medium. They demonstrated that ionic medium does not significantly change the left ventricular volume and ejection fraction, but influences the left ventricular diastolic function. Nonionic contrast material does not significantly change the left ventricular function. The mechanism of side-effects of contrast agents and possible indications for the application of nonionic contrast media are discussed.

Pulmonary wedge angiograms were compared with haemodynamic measurements at rest and during light exercise in 47 patients with chronic bronchopulmonary disease. The patients were divided into two groups on the basis of the angiograms. In group I (26 patients) less than 50% of the angiograms were abnormal, whilst in group II (21 patients) more than 50% of angiograms were abnormal. Pulmonary artery pressure and pulmonary vascular resistance were lower in group I than in group II and these differences became more marked during exercise. The pulmonary wedge pressure increased significantly on exercise in group II. Similarly, driving pressure in relation to cardiac output increased more from rest to exercise in group II than in group I. We conclude that wedge angiograms are one way to estimate the reduction in the pulmonary vascular bed.

1. Pulmonary and systemic haemodynamics during repeated exercise were studied in 28 patients with chronic lung disease of various etiology, 16 of whom suffered from chronic bronchitis. They performed a moderate exercise repeated after a 20 min rest period. Ventilatory variables, blood gas tensions, cardiac output and vascular pressures (right ventricular end-diastolic, pulmonary arterial, wedge and systemic arterial) were measured at rest, during exercise and again at rest and during the same exercise. 2. Ventilation and blood gas tensions were similar during the two rest and exercise periods; there was, however, a slightly significant difference in oxygen consumption and hydrogen ion concentration between the first and the second exercise period. Pulmonary arterial and wedge pressures were lower during the second rest and exercise, right ventricular filling pressure was lower at rest, and systemic arterial pressure during the second exercise. Cardiac output and pulmonary vascular resistance were unchanged. 3. Changes in systemic arterial pressure were significantly different in a group of patients with arterial oxygen desaturation or perfusion defects, compared with those patients without such impairment.

Fifty-six patients with kryptogenic fibrosing alveolitis were followed up during 6.3 years (from 1.5 to 19.3 years) after their first functional examination including cardiac catheterization. Twenty-two out of 56 patients died during the follow-up. The significance of individual functional tests as predictors of the survival was evaluated by means of actuarial survival probability curves. Four variables were predictive for nonsurvival: a mean pulmonary arterial pressure exceeding 30 mmHg, a vital capacity of 60% of the predicted value or lower, a CO diffusing capacity at rest less than 40% of the predicted value, an age at first symptoms over 30 years. Other variables were not significantly predictive for a given time of follow-up. A simple prognostic score derived from predictive variables was able to separate the subgroup of patients with unfavourable short-term prognosis. Among significantly predictive variables, a resting pulmonary arterial pressure over 30 mmHg appears to be the most important.

Unlabelled: Survival rates were determined for a group of 136 patients in whom left ventricular aneurysm was determined by angiography. They were treated medically (99 patients) or surgically (37 patients). Congestive heart failure was predominant in all patients. The two groups did not differ in regard to clinical and haemodynamic data except for a more extensive coronary artery disease in the surgical group. Survival rates at the 5, 7 and 9 years were 62.5%, 52.5% and 37.5% in the medicaly treated group and 50%, 40% and 32.5% in the surgical group. Functional improvement at least one Functional Class NYHA was present in 75% patients postoperatively, and in 27% of patients treated medically., Conclusion: In patients with left ventricular aneurysm with predominant congestive heart failure surgical treatment improved quality of life but did not increase long-term survival.