EC Cardiology

Introduction: Acute cardiogenic pulmonary edema is one of the reasons for admission to intensive care units. Our objective was to describe the epidemio-clinical and evolutionary profile of patients with acute cardiogenic lung edema under non-invasive ventilation and to assess the association between these different epidemio-clinical parameters with the evolution of the patients.

Methods: Acute cardiogenic pulmonary edema is one of the reasons for admission to intensive care units. Our objective was to describe the epidemio-clinical and evolutionary profile of patients with acute cardiogenic lung edema under non-invasive ventilation and to assess the association between these different epidemio-clinical parameters with the evolution of the patients.

Results: The median (IQR) age was 80 years (72 - 87) and the median (IQR) duration of hospitalization 5,8 ± 1 days with an in-hospital mortality of 22.03%. Arterial hypertension was the most common risk factor (61.41%). Acute coronary syndrome accounted for only 18.64% of etiologies. The majority of patients had a preserved left ventricular ejection fraction (50.85%). Non-invasive ventilation sessions lasting more than 24 hours were necessary in 47.46% of patients. The readmission rate during follow-up was 36.96%. A significant association was found between arterial hypertension (p = 0.046); right ventricular dysfunction (p = 0.005), the need for NIV sessions lasting more than 24 hours (p = 0.04) with hospital mortality.

Conclusion: The epidemio-clinical profile of the patients remains identical to the literature. Despite NIV, mortality is not negligible.

 Keywords: Characteristics; Non-Invasive Ventilation; Heart Failure

1. McDonagh TA., et al. “2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC”. European Heart Journal 36 (2021): 3599‑726.
2. Masip J., et al. “Indications and practical approach to non-invasive ventilation in acute heart failure”. European Heart Journal1 (2018): 17‑25.
3. Bello G., et al. “Non-invasive ventilation in cardiogenic pulmonary edema”. Annals of Translational Medicine 18 (2018): 355.
4. Peter JV., et al. “Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis”. The Lancet9517 (2006): 1155‑1163.
5. Winck JC., et al. “Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema - a systematic review and meta-analysis”. Critical Care 2 (2006): R69.
6. Lang RM., et al. “Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging”. European Heart Journal - Cardiovascular Imaging 3 (2015): 233‑271.
7. Belenguer-Muncharaz A., et al. “Non-invasive mechanical ventilation versus continuous positive airway pressure relating to cardiogenic pulmonary edema in an intensive care unit”. Archivos de Bronconeumología 10 (2017): 561‑567.
8. Masip J., et al. “Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial”. Lancet9248 (2000): 2126‑2132.
9. Gray A., et al. “Noninvasive ventilation in acute cardiogenic pulmonary edema”. New England Journal of Medicine 2 (2008): 142‑151.
10. Chow CK., et al. “Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries”. Journal of the American Medical Association9 (2013): 959‑968.
11. MacIver DH. “Current controversies in heart failure with a preserved ejection fraction”. Future Cardiology 1 (2010): 97‑111.
12. MacIver DH and Townsend M. “A novel mechanism of heart failure with normal ejection fraction”. Heart4 (2008): 446‑449.
13. Collet JP., et al. “2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)”. European Heart Journal 14 (2021): 1289‑1367.
14. Ibanez B., et al. “2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)”. European Heart Journal 2 (2018): 119‑177.
15. Parissis JT., et al. “Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital management”. European Journal of Heart Failure 11 (2010): 1193‑1202.
16. Fiutowski M., et al. “Pulmonary edema prognostic score predicts in-hospital mortality risk in patients with acute cardiogenic pulmonary edema”. Heart and Lung 1 (2008): 46‑53.
17. MacIver DH and Clark AL. “The vital role of the right ventricle in the pathogenesis of acute pulmonary edema”. American Journal of Cardiology 7 (2015): 992‑1000.
18. Bosch L., et al. “Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction”. European Journal of Heart Failure 12 (2017): 1664‑1671.
19. Salman A., et al. “The role of noninvasive ventilation in acute cardiogenic pulmonary edema”. Critical Care 2 (2010): 303.