Acute Cardiogenic Pulmonary Edema: Clinical and Noninvasive Evaluation

Left ventricular echocardiograms performed within ninety-six hours of ad mission were prospectively correlated with the clinical course in 87 consecutive patients admitted with acute pulmonary edema. Patients were stratified into four groups based on their two-dimensional echocardiogram: hyperdynamic, normal, mildly reduced, and severely reduced. Echocardiographic estimates of left ventricular function were compared with their ejection fraction measured by the gated radioisotope technique. The authors found that 48% of the patients were either normal or hyperdynamic (38% and 10% respectively). Patients in these two groups had a greater incidence of left ventricular hypertrophy (wall thickness > 13mm) (66% vs 39%, p <. 05), hypertension on admission (BP > 160/100) (66% vs 41%, p=.05), and smaller end-diastolic dimension (p <. 05) than those with decreased left ventricualr function. The authors con clude that echocardiography is a good screening test of left ventricular function in patients presenting with pulmonary edema. Patients with normal or in creased left ventricular systolic function should be evaluated for correctable or treatable causes of acute pulmonary edema.