Cardiac function and brain-type natriuretic peptide in first-time flash pulmonary edema

Jacob P. Dal-Bianco, Allan S Jaffe, Malcolm R. Bell, Jae Kuen Oh

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVE: To assess left ventricular (LV) function and brain-type natriuretic peptide (BNP) in patients with first-time flash pulmonary edema (FPE). PATIENTS AND METHODS: We retrospectively studied all patients presenting to Mayo Clinic's site in Rochester, MN, from January 5, 2000, to December 30, 2004, with FPE. Only patients with first-time FPE who had undergone BNP assessment and echocardiography within 24 hours of presentation were included. Patients were divided into 2 groups: those with reduced LV ejection fraction (LVEF) (<50%) and those with preserved LVEF (≥50%). RESULTS: Thirty-seven patients met the inclusion criteria (22 female, 15 male). Mean ± SD LVEF was 41%±13%. The LVEF was reduced in 73% (group 1, n=27; mean ± SD age, 75±8 years) and preserved in 27% (group 2, n=10; mean ± SD age, 75±13 years). Most frequent underlying causes for first-time FPE were coronary artery disease and hypertension. Patients with preserved LVEF had significantly lower BNP levels at presentation (535 pg/mL [interquartile range, 352-1210 pg/mL]) vs 1320 pg/mL (interquartile range, 768-2000 pg/mL; P=.01), despite similar elevated LV filling pressures as measured by echocardiography. The mean ± SD ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was 23±8 vs 22±10; P=.78. Early diastolic mitral annulus velocity, a surrogate measurement for myocardial relaxation, was reduced in all patients with preserved LVEF and in 95% of patients with reduced LVEF. CONCLUSION: Coronary artery disease and hypertension are the most common precipitating factors for first-time FPE. Reduced myocardial relaxation in almost all patients regardless of LVEF supports the notion that diastolic dysfunction is a prerequisite for FPE. Levels of BNP were elevated in every patient regardless of LVEF but were significantly lower in patients with preserved LVEF despite similarly elevated LV filling pressures.

Original languageEnglish (US)
Pages (from-to)289-296
Number of pages8
JournalMayo Clinic Proceedings
Volume83
Issue number3
DOIs
StatePublished - 2008

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Brain Natriuretic Peptide
Pulmonary Edema
Ventricular Pressure
Echocardiography
Coronary Artery Disease
Hypertension
Precipitating Factors
Mitral Valve
Left Ventricular Function
Stroke Volume

ASJC Scopus subject areas

  • Medicine(all)

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Cardiac function and brain-type natriuretic peptide in first-time flash pulmonary edema. / Dal-Bianco, Jacob P.; Jaffe, Allan S; Bell, Malcolm R.; Oh, Jae Kuen.

In: Mayo Clinic Proceedings, Vol. 83, No. 3, 2008, p. 289-296.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To assess left ventricular (LV) function and brain-type natriuretic peptide (BNP) in patients with first-time flash pulmonary edema (FPE). PATIENTS AND METHODS: We retrospectively studied all patients presenting to Mayo Clinic's site in Rochester, MN, from January 5, 2000, to December 30, 2004, with FPE. Only patients with first-time FPE who had undergone BNP assessment and echocardiography within 24 hours of presentation were included. Patients were divided into 2 groups: those with reduced LV ejection fraction (LVEF) (<50{\%}) and those with preserved LVEF (≥50{\%}). RESULTS: Thirty-seven patients met the inclusion criteria (22 female, 15 male). Mean ± SD LVEF was 41{\%}±13{\%}. The LVEF was reduced in 73{\%} (group 1, n=27; mean ± SD age, 75±8 years) and preserved in 27{\%} (group 2, n=10; mean ± SD age, 75±13 years). Most frequent underlying causes for first-time FPE were coronary artery disease and hypertension. Patients with preserved LVEF had significantly lower BNP levels at presentation (535 pg/mL [interquartile range, 352-1210 pg/mL]) vs 1320 pg/mL (interquartile range, 768-2000 pg/mL; P=.01), despite similar elevated LV filling pressures as measured by echocardiography. The mean ± SD ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was 23±8 vs 22±10; P=.78. Early diastolic mitral annulus velocity, a surrogate measurement for myocardial relaxation, was reduced in all patients with preserved LVEF and in 95{\%} of patients with reduced LVEF. CONCLUSION: Coronary artery disease and hypertension are the most common precipitating factors for first-time FPE. Reduced myocardial relaxation in almost all patients regardless of LVEF supports the notion that diastolic dysfunction is a prerequisite for FPE. Levels of BNP were elevated in every patient regardless of LVEF but were significantly lower in patients with preserved LVEF despite similarly elevated LV filling pressures.",
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AB - OBJECTIVE: To assess left ventricular (LV) function and brain-type natriuretic peptide (BNP) in patients with first-time flash pulmonary edema (FPE). PATIENTS AND METHODS: We retrospectively studied all patients presenting to Mayo Clinic's site in Rochester, MN, from January 5, 2000, to December 30, 2004, with FPE. Only patients with first-time FPE who had undergone BNP assessment and echocardiography within 24 hours of presentation were included. Patients were divided into 2 groups: those with reduced LV ejection fraction (LVEF) (<50%) and those with preserved LVEF (≥50%). RESULTS: Thirty-seven patients met the inclusion criteria (22 female, 15 male). Mean ± SD LVEF was 41%±13%. The LVEF was reduced in 73% (group 1, n=27; mean ± SD age, 75±8 years) and preserved in 27% (group 2, n=10; mean ± SD age, 75±13 years). Most frequent underlying causes for first-time FPE were coronary artery disease and hypertension. Patients with preserved LVEF had significantly lower BNP levels at presentation (535 pg/mL [interquartile range, 352-1210 pg/mL]) vs 1320 pg/mL (interquartile range, 768-2000 pg/mL; P=.01), despite similar elevated LV filling pressures as measured by echocardiography. The mean ± SD ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was 23±8 vs 22±10; P=.78. Early diastolic mitral annulus velocity, a surrogate measurement for myocardial relaxation, was reduced in all patients with preserved LVEF and in 95% of patients with reduced LVEF. CONCLUSION: Coronary artery disease and hypertension are the most common precipitating factors for first-time FPE. Reduced myocardial relaxation in almost all patients regardless of LVEF supports the notion that diastolic dysfunction is a prerequisite for FPE. Levels of BNP were elevated in every patient regardless of LVEF but were significantly lower in patients with preserved LVEF despite similarly elevated LV filling pressures.

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