• E Roux, B Pieri, I Bergeri, B Jauffret, L Villeneuve, and S Arquès.
• Service de cardiologie, CH Aubagne, avenue des Soeurs-Gastine, 13400 Aubagne, France.
• Ann Cardiol Angeiol (Paris). 2003 Nov 1; 52 (5): 308-12.

BackgroundBeside basal myocardial dysfunction, acute heart failure involves associated factors, which increase pulmonary capillary pressure or decrease colloid osmotic pressure. The aim of this study was to evaluate the prevalence of these precipitating factors in a population presenting with acute heart failure with preserved left ventricular systolic function.MethodsForty-eight patients (25 men, 78 +/- 10 years) presenting pulmonary edema with a left ventricular ejection fraction > 45% were included. All had a Doppler echocardiography at the time of intravenous loop diuretics initiation. Patients with severe valve disease or symptomatic coronary disease were excluded.ResultsA history of heart failure, coronary disease, hypertension and diabetes was present in 62%, 42%, 64% and 33% of patients, respectively. On admission, mean left ventricular ejection fraction was 61 +/- 9% and 79% of patients had critical elevation in Doppler filling pressures. Associated factors were renal failure (creatinine clearance < 30 ml/min) in 33% patients, silent myocardial ischemia (troponin I > 0.5 ng/ml) in 31%, atrial fibrillation in 29%, high systolic blood pressure (> or = 160 mmHg) in 27%, major sepsis in 25%, severe hypoalbuminemia (< or = 2.5 g/dl) in 23%, and severe anemia (< 10 g/dl) in 17%, respectively. Four patients had no aggravating factor, whereas 34 and 10 patients had 1-2 and 3-4 associated factors, respectively.ConclusionBesides diastolic dysfunction, factors leading to a critical decrease in the oncotic pressure such as pulmonary capillary pressure gradient are found in most of the elderly patients presenting acute diastolic heart failure and must be checked systematically.

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