The frequency distribution and severity of the cardiac disease underlying acute cardiogenic pulmonary edema(APE) to define appropriate subsequent diagnostic and management strategies were investigated in 216 consecuti...The frequency distribution and severity of the cardiac disease underlying acute cardiogenic pulmonary edema(APE) to define appropriate subsequent diagnostic and management strategies were investigated in 216 consecutive patients. To this effect, the clinical, electrocardiographic, echocardiographic and angiographic characteristics were analyzed. Coronary artery disease was identified in 185 patients(86%)-146 with acute myocardial infarction-as the underlying cause, isolated valvular disease in 10(5%) and other causes in 21(11%). Most patients were elderly(≥70 years, 72%), hypertensive(71%)and diabetic(44%). Among coronary disease(CAD) patients, however, 105(57%) showed conduction disturbances in theECG(QRS >0.10 s) and 84(45%) had no anginal pain during pulmonary edema. A 2D echocardiogram showed a 30%incidence of moderate-severe mitral regurgitation in coronary disease and non-coronary disease patients, and a 67%incidence of reduced ejection fraction(< 50%), particularly in coronary disease patients(73%). A coronary angiography performed in 99 patients with coronary disease showed multivessel disease in 89(91%) with a 32%incidence of significant left main disease. Therefore, these findings demonstrate that coronary disease is the most common cause of acute pulmonary edema and it is associated with a distinctly high prevalence of multivessel and left main disease. This diagnosis, however, may often be overlooked if no serial enzymatic sampling is performed given the increased frequency of conduction abnormalities and lack of anginal pain.展开更多
Objectives: To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis. Patients: 185 consecutive patients with acute coronary syndromes and acute p...Objectives: To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis. Patients: 185 consecutive patients with acute coronary syndromes and acute pulmonary oedema admitted to a tertiary care centre. Main outcome and measures: Clinical, ECG, echocardiographic, enzymatic, and angiographic features were prospectively investigated. Results: Non-ST segment elevation myocardial infarction(NSTEMI) was the most frequent cause of acute pulmonary oedema(61%) followed by unstable angina(UA; 21%) and ST segment elevation myocardial infarction(STEMI; 18%). In each group, mean age was ≥70 years, but NSTEMI patients were the oldest and ≥65%of patients had chronic hypertension. Moreover, patients with NSTEMI and UA were older and had a higher incidence of diabetes, previous myocardial infarction, and moderate to severe mitral regurgitation but a similarly reduced ejection fraction(NSTEMI, 41%; UA, 39%; and STEMI, 39%) and increased incidence of diastolic dysfunction and rate of multivessel disease(94%, 87%, and 86%, respectively). However, patients with STEMI had a higher creatine kinase MB peak concentration(158 v 76 μg/l in the NSTEMI group, p< 0.001) and 30 day mortality(26%v 9%in the NSTEMI group and 8%in the UA group, p< 0.024). Multivariate analysis identified ejection fraction< 40%and a peak creatine kinase MB concentration >100 μg/l as the main prognostic markers(p< 0.03). Conclusions: Acute pulmonary oedema is mostly a complication of elderly hypertensive patients with NSTEMI or UA(82%) and with multivessel disease often associated with mitral regurgitation. On the other hand, the larger infarct size and higher mortality in patients with STEMI with a similarly reduced ejection fraction suggest a more extensive acute systolic loss.展开更多
文摘The frequency distribution and severity of the cardiac disease underlying acute cardiogenic pulmonary edema(APE) to define appropriate subsequent diagnostic and management strategies were investigated in 216 consecutive patients. To this effect, the clinical, electrocardiographic, echocardiographic and angiographic characteristics were analyzed. Coronary artery disease was identified in 185 patients(86%)-146 with acute myocardial infarction-as the underlying cause, isolated valvular disease in 10(5%) and other causes in 21(11%). Most patients were elderly(≥70 years, 72%), hypertensive(71%)and diabetic(44%). Among coronary disease(CAD) patients, however, 105(57%) showed conduction disturbances in theECG(QRS >0.10 s) and 84(45%) had no anginal pain during pulmonary edema. A 2D echocardiogram showed a 30%incidence of moderate-severe mitral regurgitation in coronary disease and non-coronary disease patients, and a 67%incidence of reduced ejection fraction(< 50%), particularly in coronary disease patients(73%). A coronary angiography performed in 99 patients with coronary disease showed multivessel disease in 89(91%) with a 32%incidence of significant left main disease. Therefore, these findings demonstrate that coronary disease is the most common cause of acute pulmonary edema and it is associated with a distinctly high prevalence of multivessel and left main disease. This diagnosis, however, may often be overlooked if no serial enzymatic sampling is performed given the increased frequency of conduction abnormalities and lack of anginal pain.
文摘Objectives: To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis. Patients: 185 consecutive patients with acute coronary syndromes and acute pulmonary oedema admitted to a tertiary care centre. Main outcome and measures: Clinical, ECG, echocardiographic, enzymatic, and angiographic features were prospectively investigated. Results: Non-ST segment elevation myocardial infarction(NSTEMI) was the most frequent cause of acute pulmonary oedema(61%) followed by unstable angina(UA; 21%) and ST segment elevation myocardial infarction(STEMI; 18%). In each group, mean age was ≥70 years, but NSTEMI patients were the oldest and ≥65%of patients had chronic hypertension. Moreover, patients with NSTEMI and UA were older and had a higher incidence of diabetes, previous myocardial infarction, and moderate to severe mitral regurgitation but a similarly reduced ejection fraction(NSTEMI, 41%; UA, 39%; and STEMI, 39%) and increased incidence of diastolic dysfunction and rate of multivessel disease(94%, 87%, and 86%, respectively). However, patients with STEMI had a higher creatine kinase MB peak concentration(158 v 76 μg/l in the NSTEMI group, p< 0.001) and 30 day mortality(26%v 9%in the NSTEMI group and 8%in the UA group, p< 0.024). Multivariate analysis identified ejection fraction< 40%and a peak creatine kinase MB concentration >100 μg/l as the main prognostic markers(p< 0.03). Conclusions: Acute pulmonary oedema is mostly a complication of elderly hypertensive patients with NSTEMI or UA(82%) and with multivessel disease often associated with mitral regurgitation. On the other hand, the larger infarct size and higher mortality in patients with STEMI with a similarly reduced ejection fraction suggest a more extensive acute systolic loss.
