ORIGINAL ARTICLECardiac Function and Brain-Type Natriuretic Peptide in First-Time Flash Pulmonary Edema
Section snippets
PATIENTS AND METHODS
The study protocol was approved by the Mayo Clinic Institutional Review Board.
We retrospectively reviewed electronic and paper charts of all patients presenting to Mayo Clinic's Rochester, MN, site from January 5, 2000, to December 30, 2004, who had a diagnostic code of pulmonary edema, identifying patients with FPE. Flash pulmonary edema was defined as acute onset of dyspnea within 6 hours of seeking medical attention and the finding of pulmonary edema on chest radiograph, as suggested by
RESULTS
Thirty-seven patients (22 female; 15 male) met the inclusion criteria. Mean LVEF was 41%±13% (95% confidence interval [CI], 37%-45%). The LVEF was reduced in 73% (95% CI, 57%-85%; group 1, n=27; 75±8 years) and preserved in 27% (95% CI, 15%-43%; group 2, n=10; 75±13 years). Underlying precipitating factors and the combinations of precipitating factors for first-time FPE are shown in TABLE 1, TABLE 2. Thirteen patients (35%) had a single precipitating factor. Twenty-four patients (65%) had a
DISCUSSION
Exact determination of one main precipitating factor in patients presenting with FPE is often challenging. This is highlighted in our study; 65% of patients presented with variouscombinations of precipitating factors. Many patients had acute myocardial ischemia or elevated blood pressures (TABLE 1, TABLE 2) in combination with chronic HTN, CAD, or diabetes mellitus. This is not an accident: Enhanced myocardial relaxation in response to higher demand for LV filling is one of the main mechanisms
CONCLUSION
CAD and HTN are the most common precipitating factors for first-time FPE. Left ventricular ejection fraction was preserved in 27% of patients who presented with FPE. The E/Ea ratio was elevated equally in patients with preserved or reduced LVEF. The Ea, a surrogate marker for myocardial relaxation, was reduced in almost all patients regardless of LVEF. This supports the notion that diastolic dysfunction is a prerequisite for FPE. Age- and sex-adjusted BNP levels were elevated in every patient,
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Dr Jaffe has consulted for most of the major diagnostic companies in the past. His research and consultation are currently supported by Beckman, Dade-Behring, and Ortho Diagnostics.