St Gyalai-Korpos I, Tomescu Mirela, Pogorevici Antoanela
V. Babeş University of Medicine and Pharmacy, Cardiology Clinic, City Hospital, Timişoara, Romania.
Rom J Intern Med. 2008;46(2):153-7.
In part of hypertensive acute pulmonary oedema patients we can determine normal ejection fraction (EF) after remission of symptomatology and pulmonary congestion. In most cases echocardiography is performed after the disappearance of pulmonary oedema (APO).
Echocardiography was performed in standard views. The EF was measured by area-length monoplane method in apical 4-chamber and 2-chamber view, the final figure being an arithmetical mean of the two values. Measurement of the EF was made during APO and immediately after disappearance of symptoms and pulmonary congestion. Color, pulsed and continued Doppler were used for quantification of mitral regurgitation in apical 4-chamber and 2-chamber view.
The study included 61 patients with hypertensive APO, with systolic blood pressure (BP) >160 mmHg. From the total, 37 (60.65%) were men and 24 (39.34%) female and the mean age was 65.02 +/- 12.17 years. The systolic blood pressure (SBP) during APO was 196.97 +/- 18.89 mmHg and after treatment 132.38 +/- 11.78 with significant statistical power (p < 0.0001), with 95% confidence interval from -71.083 to -57.553. EF during APO (EF-APO) was 49.84 +/- 10.7 and after disappearance of symptomatology and pulmonary congestion (EF-nonAPO) it was 48.9 +/- 8.47. The distribution of EF values per patients is illustrated in the figure below. The values of EF-APO are significantly correlated with EF-nonAPO values (p < 0.0001, r2 = 0.9093, alpha=0.05). The linear regression of EF values during and after APO is significant (r2=0.91) and statistical significant slope (p < 0.0001, F=590). Decrease of blood pressure and remission of hypertensive APO did not alter significantly the EF in the same patient. From all patients, 27 had systolic heart failure (44.26%) after APO remission, the rest of 34 (55.74%) had EF-nonAPO >50%. From these patients with normal EF after APO remission, 31 (91.17%) also had normal EF-APO during hypertensive APO. None of these studied patients displayed significant acute mitral regurgitation during APO.
Our study showed similar EF during APO and after remission of APO in patients with hypertensive APO. Normal EF in patients after remission of hypertensive APO is pointing, with good probability, to the fact that APO was due to transitory isolated diastolic heart failure because transient systolic heart failure or/and severe mitral regurgitation were rare in these patients.
在部分高血压急性肺水肿患者中，症状和肺淤血缓解后，我们可确定其射血分数（EF）正常。多数情况下，超声心动图检查在肺水肿（APO）消失后进行。
采用标准视图进行超声心动图检查。在心尖四腔心和两腔心视图中，通过面积 - 长度单平面法测量EF，最终数值为两个值的算术平均值。在APO期间以及症状和肺淤血消失后立即测量EF。使用彩色、脉冲和连续多普勒技术在心尖四腔心和两腔心视图中对二尖瓣反流进行定量分析。
该研究纳入61例收缩压（BP）>160 mmHg的高血压APO患者。其中，男性37例（60.65%），女性24例（39.34%），平均年龄为65.02±12.17岁。APO期间的收缩压（SBP）为196.97±18.89 mmHg，治疗后为132.38±11.78 mmHg，具有显著统计学意义（p<0.0001），95%置信区间为 -71.083至 -57.553。APO期间的EF（EF - APO）为49.84±10.7，症状和肺淤血消失后的EF（EF - nonAPO）为48.9±8.47。每位患者的EF值分布如下图所示。EF - APO值与EF - nonAPO值显著相关（p<0.0001，r2 = 0.9093，α = 0.05）。APO期间和之后EF值的线性回归显著（r2 = 0.91）且斜率具有统计学意义（p<0.0001，F = 590）。血压下降和高血压APO缓解并未使同一患者的EF发生显著改变。所有患者中，27例（44.26%）在APO缓解后出现收缩性心力衰竭，其余34例（55.74%）的EF - nonAPO>50%。在这些APO缓解后EF正常的患者中，31例（91.17%）在高血压APO期间的EF - APO也正常。这些研究患者在APO期间均未出现显著的急性二尖瓣反流。
我们的研究表明，高血压APO患者在APO期间和APO缓解后的EF相似。高血压APO缓解后患者的EF正常很可能表明，APO是由短暂性单纯舒张性心力衰竭所致，因为这些患者中短暂性收缩性心力衰竭或/和严重二尖瓣反流较为罕见。
