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Measurement of pulmonary oedema in ischaemic heart disease.

Pulmonary extravascular fluid volume was measured in 64 patients with ischaemic heart disease at the time of cardiac catheterization using a double indicator dilution technique. In 3I of these patients exercise studies were done. Left ventricular and selective coronary angiography was performed in 43 and the angiographic severity of left ventricular dysfunction and of coronary artery obstructive disease was given a numerical score. There was no correlation between pulmonary extravascular fluid volume and resting left atrial pressure (r= o0i7). There was, however, a slight significant correlation between the former and PLAon exercise (r= + 0o404, p <0-025). If the patients are divided into those with normal (< I50 ml/m2) and high extravascular fluid volume (> ISO ml/m2), the high group had a slightly but significantly higher mean left atrial pressure at rest, but still within normal limits. Mean PLAin the normalgroup was normal both at rest and on exercise, but in the high group, mean PLAbecame much higher on exercise. Pulmonary extravascular fluid volume was also significantly related to the left ventricular end-diastolic pressure after left ventricular angiography (r= +o0333, P< o os) and with the angiographic grading of left ventricular dysfunction (r= +oo424, P< o oo5). It was not related to the angiographic severity of coronary artery obstructive disease. Raisedpulmonary extravascularfluid volume has been widely accepted as an index ofpulmonary oedema of which left atrial pressure is an important determinant. Pulmonary extravascular fluid volume is related to resting PLAin patients with valvular heart disease. In ischaemic heart disease patients this relation is only really apparent when the ventricle is stressed as by exercise. It is suggested that in ischaemic heart disease patients with diminished myocardial reserve, normal daily activities result infrequent rise in left atrial pres-