Louis O, Noseda A
Rev Mal Respir. 1984;1(4):233-9.
Chest radiographs, taken in the standing position, were reviewed in 47 hospitalised patients with chronic obstructive respiratory failure; the review was done retrospectively and the radiographs were examined for signs of left ventricular failure. Only interstitial and alveolar oedema were considered, upper lobe blood diversion was commonly seen in patients, probably reflecting pulmonary hypertension independent of any re-distribution of left ventricular origin. Interstitial oedema was seen in 9 patients (19.2%) of whom only one reached a pulmonary capillary pressure of 25 mmHg, traditionally considered as a threshold of interstitial oedema. In 8 other patients, the pulmonary capillary pressure was either moderately elevated between 15 and 25 mmHg (3 cases) or strictly normal (5 cases). The discordance observed between the radiological data and haemodynamics very probably reflects (bearing in mind the descriptions in valvular and ischaemic heart disease) a greater sensitivity of the radiograph when compared to measurements of pulmonary capillary pressure at rest in cases of left ventricular failure "fruste". The greater sensitivity of radiological analysis in patients suffering from chronic airflow obstruction contrasts with the classical notion, according to which the radiological expression of definite left ventricular failure was frequently poor in this kind of patient by reason of a destruction of the vascular bed, which limited the development of pulmonary oedema.
对47例住院的慢性阻塞性呼吸衰竭患者的站立位胸部X线片进行了回顾性分析，检查X线片是否存在左心衰竭迹象。仅考虑间质性和肺泡性水肿，患者中常见上叶血流重新分布，这可能反映了与左心室起源的任何重新分布无关的肺动脉高压。9例患者（19.2%）出现间质性水肿，其中只有1例患者的肺毛细血管压达到25 mmHg，传统上认为这是间质性水肿的阈值。在其他8例患者中，肺毛细血管压要么中度升高，介于15至25 mmHg之间（3例），要么完全正常（5例）。放射学数据与血流动力学之间观察到的不一致很可能反映出（考虑到瓣膜性和缺血性心脏病中的描述），与左心室衰竭“顿挫型”患者静息时肺毛细血管压测量相比，X线片具有更高的敏感性。慢性气流阻塞患者放射学分析的更高敏感性与经典观念形成对比，根据经典观念，由于血管床破坏限制了肺水肿的发展，这类患者明确的左心衰竭的放射学表现通常较差。
