Acute Cardiogenic Pulmonary Edema: Clinical and Noninvasive Evaluation

Left ventricular echocardiograms performed within ninety-six hours of admission 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 greater than 13 mm) (66% vs 39%, p less than .05), hypertension on admission (BP greater than 160/100) (66% vs 41%, p = .05), and smaller end-diastolic dimension (p less than .05) than those with decreased left ventricular function. The authors conclude that echocardiography is a good screening test of left ventricular function in patients presenting with pulmonary edema. Patients with normal or increased left ventricular systolic function should be evaluated for correctable or treatable causes of acute pulmonary edema.