Left ventricular filling hemodynamics in patients with pulmonary edema and preserved versus reduced left ventricular ejection fraction: a prospective Doppler echocardiographic study.

BACKGROUND: Objective evidence of elevated left ventricular (LV) filling pressures is infrequently demonstrated in clinical practice in patients with heart failure (HF) and preserved LV ejection fraction (LVEF) and the clinical diagnosis of HF is commonly questionable in these patients. The objective of this study was to examine whether elevated LV filling pressures can be demonstrated noninvasively in consecutive patients with HF and preserved (vs reduced) LVEF.

METHODS: Echocardiography was performed in 141 patients hospitalized with acute pulmonary edema (within 3 days of admission in 83.6%). LV filling was assessed in 116 patients without significant valve disease (median age 76 years; 51.7% men) and LV filling pressures were estimated based on mitral and pulmonary venous flow patterns and mitral annular diastolic velocities.

RESULTS: LVEF was preserved (> or =45%) in 49 patients (42.2%) and reduced (<45%) in 67 patients (57.8%). In patients with in sinus rhythm, normal LV filling pattern and abnormal relaxation, pseudonormal, and restrictive LV filling patterns (the latter two patterns associated with elevated LV filling pressures) were evident in 8, 1, 11, and 9 patients with preserved LVEF, versus 5, 11, 15, and 23 patients with reduced LVEF, respectively (P = .01) (LV filling pattern was nonconclusive in 12 patients). In patients with atrial arrhythmias, elevated LV filling pressures were evident in 4 of 14 patients with preserved LVEF and 3 of 4 patients with reduced LVEF. Overall, elevated LV filling pressures were demonstrable in 24 patients with preserved LVEF (49.0%) and in 41 patients with reduced LVEF (68.3%) (P = .26).

CONCLUSIONS: Elevated LV filling pressures are frequently evident by Doppler echocardiography in patients with HF and preserved or reduced LVEF. Thus, Doppler echocardiography can provide objective noninvasive evidence of abnormal LV filling in a large proportion of patients with HF and preserved LVEF.