Abstract 15573: Association of Concentric Left Ventricular Geometry With Acute Pulmonary Edema in Patients With Reduced Left Ventricular Ejection Fraction
Introduction: Acute pulmonary edema (APE) caused by rapid elevation of filling pressure often occurs in patients with heart failure (HF) with preserved ejection fraction (EF), but the pathogenesis of APE in patients with HF with reduced EF (HFREF) is not completely understood. Changes in LV geometry have been reported to reflect the underlying hemodynamic alterations associated with blood pressure elevation.
Hypothesis: The purpose of our study was therefore to explore the contributions of LV geometry to understand the difference between HFREF patients with or without APE.
Methods: We studied 110 consecutive acute HF patients with HFREF (<50%). APE was defined as acute onset of dyspnea with the presence of radiographic alveolar edema requiring immediate airway intervention. LV geometry was determined from LV mass/body surface area and relative wall thickness (RWT) in combination. The clinical findings and outcomes were compared between the APE group (n=30) and the non-APE group (n=80). The clinical endpoint was pre-specified as death from worsening HF, and tracked over 90 days.
Results: Patients hospitalized with APE had a higher systolic blood pressure, RWT, EF, and lower end-diastolic dimension and volume index than that with non-APE. Of the echocardiographic variables, multivariate logistic regression analysis identified that RWT was the only independent determinant of APE (OR=2.89, p=0.001). The group of concentric geometry (n=28; RWT>0.42) had higher incidence of APE compared with the group of non-concentric geometry (Figure1). Among patients presenting APE, mortality was significantly greater in patients with concentric geometry compared with patients with non-concentric geometry (Figure2).
Conclusions: Concentric geometry (increased RWT, not LV mass) has the strong association with the onset of APE in HFREF. An easily obtained echocardiographic index of RWT may enhance risk stratification of patients presenting APE in HFREF.
Author Disclosures: J. Imanishi: None. S. Yoshikawa: None. M. Nishimori: None. N. Sone: None. T. Honjo: None. K. Kaihotsu: None. M. Iwahashi: None.
- © 2016 by American Heart Association, Inc.