Acute pulmonary edema with preserved ejection fraction: clinical and prognostic profile in patients with coronary heart disease
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KeywordsAtrial Fibrillation Coronary Heart Disease Ejection Fraction Pulmonary Edema Mitral Regurgitation
To investigate the differences in the substrates, triggers and prognosis between patients who suffer an acute pulmonary edema (APE) with preserved ejection fractions and those with depressed ejection fractions.
Prospectively, during a period of 22 months all patients admitted to an emergency unit due to APE were studied. We selected for this analysis patients with documented coronary heart disease. Clinical, echocardiographic, and angiographic characteristics of patients with preserved ejection fractions (EF ≥ 50%, n = 49 [27%]) were compared with those of patients with depressed ejection fractions (EF < 50%, n = 130 [73%]). A follow-up, after a minimum of 1 year, was conducted in 96% of the cases.
Patients with EF ≥ 50% were predominantly female (30 [61%] vs 48 [37%], P < 0.001), hypertensive (41 [84%] vs 86 [66%], P = 0.02), and had an increased history of atrial fibrillation paroxysms (13 [26%] vs 15 [11%], P = 0.01). In the acute phase of pulmonary edema those patients with EF > 50% had more rapid atrial fibrillation (12 [25%] vs 8 [6%], P < 0.001) and higher systolic blood pressure levels (171 ± 50 vs 152 ± 39, P = 0.01). Between both groups, there were no differences in the extension of coronary disease, the incidence and severity of mitral regurgitation, and the presence of restrictive mitral patterns. Patients with EF ≥ 50% presented a lower 1-year global mortality rate (7 [16%] vs 46 [37%], P = 0.008) and a similar incidence of recidivism of APE episodes after discharge (14 [31%] vs 34 [33%], P = 0.85).
Patients with coronary heart disease who suffer an APE with EF > 50% present different clinical profiles than those with EF < 50% and a lower mortality rate in the follow-up. Surprisingly, however, both groups have the same probability of recurrence of APE.