ORIGINAL ARTICLE

Acute pulmonary congestion in patients with systolic heart failure versus diastolic heart failure: experience

of

a heart

emergency unit

T. Gennans, J. Tim, C.A. Visser, 0. Kamp

Background. Acute pulmonary congestion can be caused by systolic and diastolic heart failure. Whether this distinction is reflected in clinical outcome is unknown. Aim. To compare outcome after an episode of acute pulmonary congestion in patients with systolic heart failure and diastolic heart failure. Methods. A retrospective, descriptive study was conducted on consecutive patients who presented with acute pulmonary congestion. Clinical outcome was evaluated based on mortality, number of hospital re-admissions, visits to the cardiology outpatient clinic and cardiovascular events. Results. Altogether 86 patients were enrolled in this study: 59 patients (68%) had systolic dysfunction and 27 (32%) had diastolic dysfunction. Mean age was 75.6±11.0 in the systolic heart failure group and 80.1±9.4 years in the diastolic heart failure group. Mean follow-up was 427 days. Men and women were equally distributed between both patient groups. Re-admission and mortality rates were comparable between both groups. When combining cardiovascular events and mortality, patients with diastolic heart failure had more favourable outcome after acute pulmonary congestion than patients with systolic heart failure (37 vs. 70%, p=0.03). Comclusion. The proportions of patients presenting with acute pulmonary congestion due to diastolic heart failure were comparable with those found in T. Genmans J. Tim C.A. Visser 0. Kamp

Department of Cardiology, VU University Medical Centre, Amsterdam

Correspondence to: T. Germans Department of Cardiology, VU Medical Centre, PO Box 7057, 1007 MB Amsterdam E-mail: [email protected]

208

literature. Patients were mainly elderly and as often male as female. Readmission and mortality rates were comparable between both patient groups. However, patients with diastolic heart failure had a more favourable prognosis when combining cardiovascular events and mortality. (Neth Heart J2005;6:208-13.) Key words: heart failure, diastole, prognosis A cute pulmonary congestion is one of the most dramatic presentations of heart failure, requiring immediate treatment and hospital admission and has a one-year mortality between 30 to 40%.'4 Prognosis of patients after being admitted for heart failure remains poor, despite improved treatment strategies for heart failure and coronary artery disease in the past decades.5-8 Acute pulmonary congestion is associated with hypertension and typically occurs in elderly women and patients with valvular disease.39 Because a vast majority of these patients have obstructive coronary artery disease,'0"'1 the underlying mechanisms of onset of acute pulmonary congestion are thought to be ischaemia-induced transient reduction of left ventricular ejection fraction and/or mitral regurgitation, although this hypothesis has never been confirmed.'2 The only alterations in left ventricular function found during the acute episode of acute pulmonary congestion were impaired diastolic parameters.12 In addition, in nearly halfofthe patients presenting with acute pulmonary congestion, left ventricular diastolic dysfunction persists after the acute episode. To date, it is unknown whether the clinical course after acute pulmonary congestion is different between patients with systolic and diastolic heart failure. Therefore, the aim of this study was to compare outcome of patients with systolic heart failure to patients with diastolic heart failure after presentation with acute pulmonary congestion regarding mortality, cardiac Nether2andes Heart Journal, Volume 13, Number 6, June 2005 fc

Acute pulmonary congestion in patients with systolic heart failure versus diastolic heart failure: experience of a heart emergency unit

Table 1. Baseline characteristics. Systolic heart filure Mean age Sex - Male - Female Mean blood pressure (mmHg) -

Systolic

- Diastolic Mean heartbeat at admission (/min)

Risk factors for CAD None Diabetes

Hypertension Positive family history Hyperlipidaemia Smoking Mean body mass index (kg/M2) Medical history None NYHA class -N c -II -I1I -IV Myocardial infarction Angina pectoris Cardiomyopathy

(n=59)

Diastolic heart failure (n=27)

80.1±9.4

75.6±11.0

P value ns ns

24(41%) 35 (59%)

13(48%) 14 (52%)

173±31 93±28.8 105

186±19.3 100±10.2 94

0.05 ns 0.05

14(24%) 20 (34%) 29 (49%) 10 (17%) 12 (20%) 20 (34%) 27.4±4.53

1(4%) 9 (33%) 21 (78%) 5 (19%) 6 (22%) 6 (22%) 30.0±5.22