New insights into diastolic dysfunction as the cause of acute left-sided heart failure associated with systemic hypertension and/or coronary artery disease

Abstract

The precise pathophysiologic mechanism responsible for the clinical expression of acute pulmonary edema is not well defined. In particular, it is unclear whether there is an acute worsening of systolic and/or diastolic function or acutely reversible or transiently more severe mitral regurgitation. 1 Vasan R.S Benjamin E.J Levy D Prevalence, clinical features and prognosis of diastolic heart failure an epidemiologic perspective. J Am Coll Cardiol. 1995; 26: 1565-1574 Abstract Full Text PDF PubMed Scopus (771) Google Scholar , 2 Braunwald E Colucci W.S Grossman W Clinical aspects of heart failure high-output heart failure; pulmonary edema. in: Braunwald E Heart Disease: A Textbook of Cardiovascular Medicine. WB Saunders Company, Philadelphia, PA1997: 445-470 Google Scholar , 3 Stone G.W Griffin B Shah P.K Berman D.S Siegel R.J Cook S.L Maurer G Prevalence of unsuspected mitral regurgitation and left ventricular diastolic dysfunction in patients with coronary artery disease and acute pulmonary edema associated with normal or depressed left ventricular systolic function. Am J Cardiol. 1991; 67: 37-41 Abstract Full Text PDF PubMed Scopus (31) Google Scholar , 4 Gheorghiade M Bonow R.O Chronic heart failure in the United States a manifestation of coronary artery disease. Circulation. 1998; 97: 282-289 Crossref PubMed Scopus (665) Google Scholar This may be because evaluation of cardiac function is generally performed some time after a patient’s initial stabilization. 3 Stone G.W Griffin B Shah P.K Berman D.S Siegel R.J Cook S.L Maurer G Prevalence of unsuspected mitral regurgitation and left ventricular diastolic dysfunction in patients with coronary artery disease and acute pulmonary edema associated with normal or depressed left ventricular systolic function. Am J Cardiol. 1991; 67: 37-41 Abstract Full Text PDF PubMed Scopus (31) Google Scholar , 5 McDermott M.M Feinglass J Sy J Gheorghiade M Hospitalized congestive heart failure patients with preserved versus abnormal left ventricular systolic function clinical characteristics and drug therapy. Am J Med. 1995; 99: 629-635 Abstract Full Text PDF PubMed Scopus (110) Google Scholar , 6 Madsen B.K Hansen J.F Stockholm K.H Brøns J Husum D Mortensen L.S Chronic congestive heart failure description and survival of 190 consecutive patients with a diagnosis of chronic congestive heart failure based on clinical signs and symptoms. Eur Heart J. 1994; 15: 303-310 Crossref PubMed Scopus (141) Google Scholar , 7 Dougherty A.H Naccarelli G.V Gray E.L Hicks C.H Goldstein R.A Congestive heart failure with normal systolic function. Am J Cardiol. 1984; 54: 778-882 Abstract Full Text PDF PubMed Scopus (555) Google Scholar Loading conditions, medications, and the patient’s condition may then be quite different and the cardiac evaluation may no longer reflect the original decompensated state. Therefore, in the absence of characterization of cardiac function at the time of acute presentation, pertinent, perhaps unsuspected, information about pathophysiologic mechanisms associated with acute left-sided heart failure may be missed. This echocardiographic study was undertaken to gain insight into these mechanisms.