Possible Contribution of Right and Left Ventricular Stroke Volume Mismatch for the Development of Acute Pulmonary Edema

Mclver has been suggested that right and left ventricular stroke volume mismatch (RL-SVM) is one of the mechanism of acute pulmonary edema(APE). We compared clinical characteristics of acute decompensated heart failure (ADHF) according to the inetrval (INT) between the appearance or exacerbation of heart faillure symptom and admission. Methods: We researched consecutive 152 patients with ADHF by classifying them into 3 groups, INT<6 hr (APE1), 6 hr<INT<24 hr (APE2), INT>24 hr (cardiac failure; CF). The following parameters were determined on admission; complication of (paroxysmal) atrial fibrillation (Afl), enlargement of right side heart (right atrium>40 mm and/or right ventricle>43 mm), grade of tricuspid regurgitation (TR), oxygen saturation (SAT), systolic BP, HR, grade of mitral regurgitation (MR), extracellular water measured by impedance methods (MP ratio). Results: APE1, APE2 and CF were 12%, 9%, and 69%, respectively. In APE1, Afl was least (25, 68, a64%). enlargement of RA/RV was least (6, 42, 69%), the grade of TR was least (0.6±0.7, 1.2±0.8, 1.4±0.9), sBP was highest (180±31, 148±10, 136±29 mmHg), SAT was lowest (81±8, 90±7, 94±5%). In contrast, MP ratio and MR were not different among 3 groups. Conclusions: Relatively preserved right heart function compared with left heart which exposed highly afterload under desaturation in APE1 was observed consistent with the concept of RL-SVM.