The impact of echocardiographic substrate on short and medium term prognosis in non-acute coronary syndrome pulmonary edema

Background: Acute pulmonary edema (APE) is a severe clinical form of acute heart failure (AHF) with a high in-hospital (IH) and early post-discharging mortality. Aim: To identify the morphofunctional substrate in non ACS APE, based on the clinical, anamnestic and echocardiographic evidence and to analyze how it correlates with the short and medium term prognosis. Material and methods: The study included 228 patients divided into two samples of 136 patients suffering from chronic decompensated acute heart failure, and 92 patients admitted for APE. Echocardiography was performed in every patient and three etiologies were taken into analysis: ischemic, valvular and hypertensive. The survivors were followed up for one. We recorded the IH, 30 days and 12 month mortality. Results: There were 47.83% (44) patients with ischemic etiology, 23.91% (22) valvular, and 28.26% (26) hypertensive. In entire group the IH, 30 days and 12 months mortality was: 9.64%, 4.48% and 28.25%. We did not find a significant correlation between the IH mortality and the etiology (p=0.63), but we found a high IH mortality for each underlying etiology: 57.27% for ischemic, 18.18% for valvular and 23.08% for hypertensive. Thirty days mortality was influenced by ischemic etiology, the only cause for 30 days death, at the limit of significant statistical data (p=0.053, RR 1.0750, 95% CI 1.0145-1.1391). The 12 months mortality was significantly influenced by ischemic etiology (RR 1.4321, 95% CI 1.0288-2.0022, p=0.01); 12 month death was 68.42% for ischemic and 31.58% for valvular etiology. A low BP (blood pressure) at presentation was significantly correlated with 12 months mortality in ischemic APE patients (p=0.04). A high heart rate (HR) at presentation was correlated with IH mortality for hypertensive patients (p=0.07) and a low HR with 12 month mortality in valvular APE patients (p=0.02). The only biological parameter with independent prognostic value for the mortality at any given moment was sodium seric levels at presentation (p