Peripheral edema due to heart disease: Diagnosis and outcome

Background: The purpose of this study was to determine whether baseline physical examination and history are useful in identifying patients with cardiac edema as defined by echocardiography, and to compare survival for patients with cardiac and noncardiac causes of edema. Hypothesis: Physical examination and history data can help to identify patients with edema who have significant cardiac disease. Methods: We reviewed the medical records of 278 consecutive patients undergoing echocardiography for evaluation of peripheral edema. We classified cardiac edema as the presence of any of the following: left ventricular ejection fraction <45%, systolic pulmonary artery pressure >45 mmHg, reduced right ventricular function, enlarged right ventricle, and a dilated inferior vena cava. Results: The mean age of the 243 included patients was 67 ± 12 years and 92% were male. A cardiac cause of edema was found in 56 (23%). Independent predictors of a cardiac cause of edema included chronic obstructive pulmonary disease (COPD, odds ratio [OR] 1.74,95% confidence interval [CI] 1.14-2.60) and crackles (OR 1.98, 95% CI 1.26-3.10). The specificity for a cardiac cause of edema was high (91% for COPD, 93% for crackles); however, the sensitivity was quite low (27% for COPD, for 24% crackles). Compared with patients without a cardiac cause of edema, those with a cardiac cause had increased mortality (25 vs. 8% at 2 years, p < 0.01), even after adjustment for other characteristics (hazard ratio 1.55, 95% CI 1.08-2.24). Conclusions: A cardiac cause of edema is difficult to predict based on history and examination and is associated with high mortality.