Pathophysiology of Lower Extremity Edema in Acute Heart Failure Revisited - 23/10/12
, Affan Irfan, MD a, d, , Theresia Klima, MD c, Beatrice Drexler, MD a, e, Cathrin Balmelli, MD a, e, Nisha Arenja, MD a, e, Thenral Socrates, MD a, e, Rebekka Ringger, MD a, Corinna Heinisch, MD a, e, Ronny Ziller, MD a, e, Jürg Schifferli, MD a, Christophe Meune, MD, PhD a, f, Christian Mueller, MD a, e, ⁎ 
Requests for reprints should be addressed to Christian Mueller, MD, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandAbstract |
Background |
The pathophysiology and key determinants of lower extremity edema in patients with acute heart failure are poorly investigated.
Methods |
We prospectively enrolled 279 unselected patients presenting to the Emergency Department with acute heart failure. Lower extremity edema was quantified at predefined locations. Left ventricular ejection fraction, central venous pressure quantifying right ventricular failure, biomarkers to quantify hemodynamic cardiac stress (B-type natriuretic peptide), and the activity of the arginine-vasopressin system (copeptin) also were recorded.
Results |
Lower extremity edema was present in 218 (78%) patients and limited to the ankle in 22%, reaching the lower leg in 40%, reaching the upper leg in 11%, and was generalized (anasarca) in 3% of patients. Patients in the 4 strata according to the presence and extent of lower leg edema had comparable systolic blood pressure, left ventricular ejection fraction, central venous pressure, and B-type natriuretic peptide levels, as well as copeptin and glomerular filtration rate (P=NS for all). The duration of dyspnea preceding the presentation was longer in patients with more extensive edema (P=.006), while serum sodium (P=.02) and serum albumin (P=.03) was lower.
Conclusion |
Central venous pressure, hemodynamic cardiac stress, left ventricular ejection fraction, and the activity of the arginine-vasopressin system do not seem to be key determinants of the presence or extent of lower extremity edema in acute heart failure.
Le texte complet de cet article est disponible en PDF.Keywords : B-type natriuretic peptide, Central venous pressure, Copeptin, Edema, Heart failure, Left ventricular ejection fraction
Plan
| Funding: The study was supported by a research grant from the Department of Internal Medicine of the University Hospital Basel to Dr Breidthardt. |
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| Conflict of Interest: None. |
Vol 125 - N° 11
P. 1124.e1-1124.e8 - novembre 2012 Retour au numéro
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