Edema Linked To Diastolic Dysfunction

Edema in patients with hypertensive pulmonary edema may be due to the exacerbation of diastolic dysfunction by hypertension – not to transient systolic dysfunction or mitral regurgitation.

Patients with acute pulmonary edema often have marked hypertension. Yet, after reduction of the blood pressure, they have a normal left ventricular ejection fraction.

These researchers studied 14 men and 24 women averaging 67 years of age and all with acute pulmonary edema and systolic blood pressure (BP) greater than 160 mm Hg.

Both during the acute episode and one to three days after treatment, the patients’ ejection fractions and regional function were evaluated.

Mean systolic blood pressure averaged 200 mg Hg during initial echocardiographic examination and was reduced to about 139 mm Hg at the time of follow-up exam.

However, despite the marked difference in blood pressure, the ejection fraction was similar during the acute episode and after treatment.

The left ventricular regional wall-motion index was also the same during the acute episode and after treatment.

No patient had severe mitral regurgitation during acute episode. After treatment, 18 patients had a normal ejection fraction.

In 16 of these 18 patients, the ejection fraction was at least 0.50 during the acute episode.

The researchers from Wake Forest University, Winston-Salem, North Carolina, United States, concluded that the normal ejection fraction after treatment suggests the edema in these patients was due to exacerbation of diastolic dysfunction by hypertension and not to transient systolic dysfunction or mitral regurgitation.

N Engl J Med 2001;344:17-22