Hypertensive acute pulmonary oedema as expression of diastolic heart failure

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 (APO).

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 were used for quantification of mitral regurgitation in apical 4-chamber and 2-chamber view.

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 APO 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) it was 48.9 +/- 8.47. The distribution of EF values per patients is illustrated in the figure below. The values of EF-APO 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 did not 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%) also had normal EF-APO during hypertensive APO. None of these studied patients displayed significant acute mitral regurgitation during APO.

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, to 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.