- Abstract -
In part of
hypertensive acute pulmonary oedema patients we can
determine normal ejection fraction (EF) after
remission of symptomatology and pulmonary
congestion. In most cases echocardiography is
performed after the disappearance of pulmonary
oedema (APE).
Methods:
Echocardiography was performed in standard views.
The EF was measured by area-length monoplane method
in apical 4-chamber and 2-chamber view, the final
figure being an arithmetical mean of the two values.
Measurement of the EF was made during APO and
immediately after disappearance of symptoms and
pulmonary congestion. Color, pulsed and continued
Doppler was used for quantification of mitral
regurgitation in apical 4-chamber and 2-chamber
view.
Results: The study
included 61 patients with hypertensive APO, with
systolic blood pressure (BP) >160 mmHg. From the
total, 37(60.65%) were men and 24(39.34%) female and
the mean age was 65.02±12.17 years. The systolic
blood pressure (SBP) during EPO was 196.97±18.89
mmHg and after treatment 132.38±11.78 with
significant statistical power (p<0.0001), with 95%
confidence interval from -71.083 to -57.553.
EF during
APO (EF-APO) was 49.84±10.7 and after disappearance
of symptomatology and pulmonary congestion (EF-nonAPO)
was 48.9±8.47. The distribution of EF values per
patients is illustrated in figure below. The values
of EF-EPO are significantly correlated with
EF-nonAPO values (p<0.0001, r2=0.9093,
alpha=0.05).
The linear
regression of EF values during and after APO is
significant (r2=0.91) and statistical
significant slope (p<0.0001, F=590).
Decrease of
blood pressure and remission of hypertensive APO
didn’t alter significantly the EF in the same
patient.
From all
patients, 27 had systolic heart failure (44.26%)
after APO remission, the rest of 34 (55.74%) had
EF-nonAPO >50%. From these patients with normal EF
after APO remission, 31 (91.17%) had also normal EF-APO
during hypertensive APO.
None of
these studied patients displayed significant acute
mitral regurgitation during APO.
Conclusions: Our
study showed similar EF during APO and after
remission of APO in patients with hypertensive APO.
Normal EF in patients after remission of
hypertensive APO is pointing, with good probability,
the fact that APO was due to transitory isolated
diastolic heart failure because transient systolic
heart failure or/and severe mitral regurgitation
were rare in these patients.
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Creanga Madalina
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