Plasma Disappearance of Albumin and Impact of Capillary Thickness in Idiopathic Dilated Cardiomyopathy and After Heart Transplantation

Abstract

BACKGROUND-The increased plasma disappearance of albumin has previously been described in decompensated congestive heart failure (CHF); this disappearance normalized after diuretic treatment. Cardiac transplantation (HTX) and current medical treatment affect microvascular structure and function. We investigated the plasma disappearance of albumin and the impact of microvascular thickness and electrostatic properties in patients with compensated CHF and after HTX. METHODS AND RESULTS-The fraction of intravascular albumin that passes to the extravascular space per unit time, as determined from the plasma disappearance of intravenously injected (131)I-labeled albumin, was increased to 7.8+/-1.7% in 16 patients with CHF compared with 18 controls (6.5+/-1.9%, P<0.05); these levels normalized after HTX (5.8+/-2.6%, P<0.01, n=17). The change in ratio between (131)I-albumin and simultaneously injected negatively charged glycosylated (125)I-albumin (selectivity index, >1/hour in controls) was lower in patients with HTX (0.993+/-0. 022/hour) than in controls (1.008+/-0.019/hour; P<0.05), which indicated a relatively increased plasma disappearance of negatively charged albumin in HTX patients. Capillary basement membrane thickness was evaluated semiquantitatively from skin biopsies and showed no difference in the 3 groups (control, CHF, and HTX patients). However, in all 3 study groups, subjects with thicker capillary basement membranes had lower albumin escape rates (6.1+/-1. 8%, n=32, versus 7.6+/-2.6% in subjects without thickening of capillary basement membranes, n=19; P<0.05). CONCLUSIONS-The plasma disappearance of albumin increased in patients with compensated CHF and it normalized after HTX. The present normalized capillary basement thicknesses in patients with CHF and the direct association between this parameter and plasma albumin disappearance indicate that previous compensatory microvascular basement membrane growth results in restricted permeability. Microvascular electrostatic properties did not relate to plasma albumin disappearance.

Evaluation of Arteriolar Hyalinosis of the Skin of Patients With Chronic Congestive Heart Failure.

“…However, the reason could be the present patients' relative long-term duration of CHF (mean duration = 3.5 years). The results may reflect the individual's vascular susceptibility to hypoxia or oxidative stress, [8][9][10] but the mechanisms by which these structural abnormalities develop are still unclear.…”

Importance of the evaluation of serum albumin concentration in postoperative period of patients submitted to major surgeries

“…Since organic defense decrease and malnutrition were recognized as potential factors for higher morbidity and mortality rates in the postoperative period, many studies have dealt with the early detection of immunosuppression and malnourishment in surgical patients 3,6 . Malnourished patients are at higher risk of postoperative complications and death, if compared to well-nourished patients submitted to similar surgeries.…”

“…Among the systemic responses, hepatocyte response stands out, with decreased synthesis of albumin and ferritin. On the other hand, there is an increase in serum C-reactive protein concentration, ceruloplasmin and other proteins related to the immune processes 6,13 . Specifically, albumin is a protein synthesized by the liver, with a long mean life (21 days), hence variations in its concentration during a short interval can not be explained by nutrition or liver function alterations 17 .…”

Biokinetic Modeling and Dosimetry for Optimizing Intraperitoneal Radioimmunotherapy of Ovarian Cancer Microtumors

“…The subsequent 2-way kinetics for molecules transported in and between plasma and the intercellular volume were then modeled using a transport rate of 6.5%/h from plasma, as reported for radiolabeled albumin (17). Use of the same transport rate for intercellular volume to plasma provided model results that were a good fit to the patients' measured plasma concentrations.…”