Cardiology Division, Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, Bergamo.
Department of Cardiac Surgery and Transplantation, AORN dei Colli Monaldi-Cotugno-CTO Naples.
J Cardiovasc Med (Hagerstown). 2022 Oct 1;23(10):663-671. doi: 10.2459/JCM.0000000000001366.
Limited data are available on right (RV) and left (LV) ventricular structures and functions in acute heart failure with preserved ejection fraction (AHF-pEF) presenting with hypertensive pulmonary edema (APE) versus predominant peripheral edema (peHF).
In a prospective study of consecutive patients with AHF-pEF, 80 patients met inclusion and not exclusion criteria, and underwent echocardiographic and laboratory examination in the emergency ward. The survived (94%) were re-evaluated at the discharge. At admission, systolic, diastolic, pulse blood pressure (BP), and high sensitivity troponin I were higher (all P < 0.05) with APE than with peHF while brain-type natriuretic peptide (BNP), hemoglobin and estimated glomerular filtration rate (eGFR) did not differ between the two phenotypes. LV volumes and EF were comparable between APE and peHF, but APE showed lower relative wall thickness (RWT), smaller left atrial (LA) volume, higher pulse pressure/stroke volume (PP/SV), and higher ratio between the peak velocities of the early diastolic waves sampled by traditional and tissue Doppler modality (mitral E/e', all P < 0.05). Right ventricular and atrial (RA) areas were smaller, tricuspid anular plane systolic excursion (TAPSE) and estimated pulmonary artery peak systolic pressure (sPAP) were higher with APE than with peHF (all P < 0.05) while averaged degree of severity of tricuspid insufficiency was greater with peHF than with APE. At discharge, PP/SV, mitral E/e', sPAP, RV sizes were reduced from admission in both phenotypes (all P < 0.05) and did not differ anymore between phenotypes, whereas LV EF and TAPSE did not show significant changes over time and treatments.
In AHF-pEF, at comparable BNP and LV EF, hypertensive APE showed eccentric LV geometry but smaller RV and RA sizes, and higher RV systolic function, increased LV ventricular filling and systemic arterial loads. AHF resolution abolished the differences in PP/SV and LV diastolic load between APE and peHF whereas APE remained associated with more eccentric RV and higher TAPSE.
在射血分数保留的急性心力衰竭（AHF-pEF）中，伴有高血压性肺水肿（APE）的患者与以周围性水肿为主的心力衰竭（peHF）相比，右心室（RV）和左心室（LV）结构和功能的相关数据有限。
在一项对连续的 AHF-pEF 患者进行的前瞻性研究中，80 名患者符合纳入标准而非排除标准，并在急诊病房进行了超声心动图和实验室检查。存活（94%）的患者在出院时进行了重新评估。入院时，APE 患者的收缩压、舒张压、脉压（BP）和高敏肌钙蛋白 I 均高于 peHF（均 P<0.05），而脑利钠肽（BNP）、血红蛋白和估算肾小球滤过率（eGFR）在两种表型之间无差异。APE 和 peHF 之间的 LV 容积和 EF 相似，但 APE 的相对室壁厚度（RWT）较低、左心房（LA）容积较小、脉压/每搏量（PP/SV）较高、传统和组织多普勒取样的舒张早期波峰值速度之比（E/e'）较高（均 P<0.05）。右心室和心房（RA）面积较小，三尖瓣环平面收缩期位移（TAPSE）和估测肺动脉收缩压峰值（sPAP）在 APE 患者中高于 peHF（均 P<0.05），而 peHF 患者的三尖瓣反流程度更严重。出院时，两种表型的 PP/SV、E/e'、sPAP、RV 大小均较入院时降低（均 P<0.05），且两种表型之间无差异，而 LV EF 和 TAPSE 随时间和治疗无明显变化。
在 AHF-pEF 中，在 BNP 和 LV EF 相似的情况下，伴有高血压的 APE 表现为偏心性 LV 几何结构，但 RV 和 RA 较小，RV 收缩功能较高，LV 心室充盈和全身动脉负荷增加。AHF 缓解消除了 APE 和 peHF 之间在 PP/SV 和 LV 舒张负荷方面的差异，而 APE 仍然与更偏心的 RV 和更高的 TAPSE 相关。
