The role of isolated diastolic heart failure as a cause for hospitalisation in patients with pulmonary oedema

We report a prospective review of 117 consecutive acute admissions with pulmonary oedema over a seven month period (Jan-July 1997) looking for isolated diastolic dysfunction. Subjects: 117 consecutive patients admitted acutely with pulmonary oedema (excluding those with acute MI) were assessed by clinical examination, electrocardiograph, chest x-ray, and echocardiography. Results: Seventeen cases were excluded (12 of whom had previous myocardial infarction) due to inadequate quantitative imaging. In the remaining patients (n=100) there was a high prevalence of IHD (61%), hypertension (33%), and diabetes mellitus (20%). Eighty patients had impaired systolic function (FS <20%). Ten patients had significant primary valvular disease (3AS; 1MR; 4MS; 2 Prosthetic valve dysfunction). Seven patients presented with atrial fibrillation, LVH (LVMI 185.8 ± 28.21 g/m²) and normal systolic function. One patient presented with a normal echo and lone atrial fibrillation. One patient presented with sick sinus syndrome and a normal echo. A further one patient presented in sinus rhythm, with hypertensive LVH, normal systolic function and impaired diastolic relaxation indices. Conclusion: In this sample normal cardiac systolic and valvular function was present in 10% of patients hospitalised with pulmonary oedema. In these patients the combination of hypertensive LVH and atrial fibrillation was prevalent and impaired diastolic filling may have contributed to pulmonary oedema. Isolated diastolic heart failure is rarely a cause of pulmonary oedema.