Introduction: Ventricular interdependence and right ventricle(RV) function as etiopathogeny in Acute Pulmonary Edema(APE) has been a subject of interest in our days. It is known that a proper function of the RV favors the onset of an episode of APE in patients with Acute Coronary Syndromes(ACS) associeted with left ventricular dysfunction. What about RV role in APE outside of ACS?
Scope: To study the prognostic role of RV in patients with non-ACS APE and the correlation of the RV echo parameters with the early outcomes, in relation with ethiology.
Methods: 92 patients with non-ACS APE consecutively hospitalized in our clinic between 01.01-31.12.2015, distributed and analyzed according to three etiologies: ischemic, primary valvular and hypertensive(with preserved LVEF, without significant valvular or documented coronary artery disease). An echocardiography was performed on admission.We analyzed three RV parameters: Tricuspid annular plane systolic excursion(TAPSE), Pulmonary artery acceleration time(PAT), Right atrium-right ventricle pressure gradient(RA-RV PG).We identified the correlation of these parameters with in hospital mortality(IHM) in the entire group and according with underlying ethiology.
Results: In the whole group of patients all three parameters, in a univariate analysis, were statistically significant (SS) associated with IHM (p<0.01) with the following cutt of values(COV) at ROC curve: TAPSE<17 mm(p<0.01), PAT<92ms(p<0.01), RA-RV PG>41mmHg(p<0.01). The prognostic value has been changed when was correleted with ethiology. Remained SS for hypertensive substrate TAPSE, PAT and RV-RA PG (p<0.01); for ischemic group TAPSE(p=0.01) and PAT (p<0.01) and for valvular patients RV-RA PG(p=0.02), all with the same COV as in the entire group.
Conclusions: In our non ACS APE patients group the RV had a significant prognostic role. Right ventricule dysfunction(TAPSE<17mm) and pulmonary hypertension(PAT<92ms and RA-RV PG>41mmHg) was significatly associated with in hospital mortality(p<0.01). The prognostic value of this parameters was changed by ethiology. So, to look at RV is also very important in APE patients!