This is a retrospective study of patients presenting to Mayo Clinic, Rochester, MN, from January 5, 2000, to December 30, 2004, with flash pulmonary edema. Only patients with first-time flash pulmonary edema who had undergone brain-type natriuretic peptide assessment and echocardiography within 24 hours of presentation were included. Patients were divided into 2 groups: those with reduced left ventricular ejection fraction (<50%) and those with preserved left ventricular ejection fraction (≥50%)
Dal Bianco, Jacob P, et al. "Cardiac function and brain-type natriuretic peptide in first-time flash pulmonary edema.” Mayo Clinic proceedings 83.3 (2008):289-296.
Coronary artery disease and hypertension are the most common precipitating factors for first-time flash pulmonary edema. Left ventricular ejection fraction was preserved in 27% of patients who presented with flash pulmonary edema. The E/Ea ratio was elevated equally in patients with preserved or reduced left ventricular ejection fraction. The Ea, a surrogate marker for myocardial relaxation, was reduced in almost all patients regardless of left ventricular ejection fraction. This supports the notion that diastolic dysfunction is a prerequisite for flash pulmonary edema. Age- and sex-adjusted brain-type natriuretic peptide levels were elevated in every patient, even when brain-type natriuretic peptide was assayed early after dyspnea onset. Levels of brain-type natriuretic peptide were lower in patients with flash pulmonary edema and a preserved reduced left ventricular ejection fraction than in patients with a reduced reduced left ventricular ejection fraction.