| Cardiac function and brain-type natriuretic peptide in first-time flash pulmonary edema. | |
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MedLine Citation:
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PMID: 18315994 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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) (less than 50%) and those with preserved LVEF (equals 50%). RESULTS: Thirty-seven patients met the inclusion criteria (22 female, 15 male). Mean plus or minus SD LVEF was 41% plus or minus 13%. The LVEF was reduced in 73% (group 1, n equals 27; mean plus or minus SD age, 75 plus or minus 8 years) and preserved in 27% (group 2, n equals 10; mean plus or minus SD age, 75 plus or minus 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 equals .01), despite similar elevated LV filling pressures as measured by echocardiography. The mean plus or minus SD ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was 23 plus or minus 8 vs 22 plus or minus 10; P equals .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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Authors:
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Jacob P Dal-Bianco; Allan S Jaffe; Malcolm R Bell; Jae K Oh |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Mayo Clinic proceedings. Mayo Clinic Volume: 83 ISSN: 0025-6196 ISO Abbreviation: Mayo Clin. Proc. Publication Date: 2008 Mar |
Date Detail:
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Created Date: 2008-03-04 Completed Date: 2008-04-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0405543 Medline TA: Mayo Clin Proc Country: United States |
Other Details:
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Languages: eng Pagination: 289-96 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Biological Markers / blood Echocardiography, Doppler Electrocardiography Female Follow-Up Studies Humans Male Myocardial Contraction / physiology* Natriuretic Peptide, Brain / blood* Prognosis Pulmonary Edema / blood, diagnosis, physiopathology* Radiography, Thoracic Retrospective Studies Severity of Illness Index Stroke Volume / physiology* Troponin T / blood Ventricular Function, Left / physiology* Ventricular Pressure / physiology* |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Troponin T; 114471-18-0/Natriuretic Peptide, Brain |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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