Interstitial colloid osmotic and hydrostatic pressures in human subcutaneous tissue during early stages of heart failure.

Subcutaneous oedema is a common finding in heart failure. However, some patients have reduced cardiac pump function without oedema. The aim of this study was to investigate whether local mechanisms in subcutaneous tissue contribute to oedema prevention. A reduction in interstitial colloid osmotic pressure (pii) and a rise in interstitial fluid hydrostatic pressure (Pi) will both counteract a rise in capillary filtration caused by heart failure. Cardiac catheterization was done in 22 angina pectoris patients without visible oedema. Two days later pii was measured with a wick method and Pi was measured with a wick-in-needle method. Both parameters were measured in subcutaneous tissue on thorax at heart level and on the ankle. Plasma volume was determined by 125I-albumin and extracellular volume measured with 35SO4. Parameters of cardiac pump function ranged from normal to clearly pathological values. Mean pii was 13.0 mmHg on thorax and 8.3 mmHg on the ankle. Pi averaged -2.1 mmHg on thorax and -1.5 mmHg on the ankle. Statistically significant (P less than 0.05) correlations were found between pii on thorax and left ventricular end diastolic pressure (rs -0.40) and pii on thorax and cardiac index (rs 0.42). Pi was positively correlated to right atrial pressure (rs 0.50). Body fluid volumes were normal or moderately reduced. The study shows that a reduction in cardiac pump function is associated with a reduction in pii and a rise in Pi. These changes may help to prevent oedema formation in the early stages of heart failure.