Acute pulmonary edema in the emergency department: clinical and echocardiographic survey in an aged population.

BACKGROUND

This study is aimed at better defining the prevalence of left ventricular dysfunction, atrial fibrillation, and mitral regurgitation in aged patients with cardiogenic acute pulmonary edema.

METHODS

One hundred and twenty-three consecutive patients with acute pulmonary edema (APE) arriving at the emergency department of a peripheral hospital who underwent Doppler echocardiography within 36 hours of admission were reviewed retrospectively.

RESULTS

Left ventricular ejection fraction (LVEF) was normal or near normal (ie, LVEF > or = 40%) in 41.4% (n = 51 patients), and depressed in 58.5% (n = 72). Significant valvular dysfunction was present in 37.4%; mitral regurgitation was the most frequent (22.8%; n = 28). We found a significant positive correlation between systolic blood pressure (SBP) and LVEF (P = 0.003). Within the group of patients presenting with lower SBP (< or = 140 mm Hg), as blood pressure diminished, LVEF also diminished significantly (P = 0.008). In a logistic regression analysis, male sex and SBP of less than 120 mm Hg were found to be the strongest predictors for LVEF < or = 40%, conferring a 2.68- and 2.73-fold risk, respectively (95%CI, 1.19 to -6.00; P = 0.016 and 95%CI, 0.956-7.80; P = 0.061, respectively) compared with female sex and higher SBP groups.

CONCLUSIONS

This study emphasizes that emergency departments should have clear-cut policies for diagnosing and treating acute coronary syndromes and tachyarrhythmias, as being potential treatable causes of APE. Once stabilized, patients should be examined for treatable valvular causes. A further study, of acute echocardiography done upon arrival to the emergency department in patients with APE is warranted.