Vol 71, No 7 (2013)
Original articles
Published online: 2013-07-17
Cardiogenic pulmonary oedema: alarmingly poor long term prognosis. Analysis of risk factors
DOI: 10.5603/KP.2013.0158
Kardiol Pol 2013;71(7):712-720.
Abstract
Background: Acute heart failure (AHF) is a life-threatening condition associated with poor prognosis.
Aim: To investigate the long term prognosis and identify prognostic factors among patients who were discharged after an
episode of cardiogenic pulmonary oedema.
Methods: We enrolled 84 patients (M: 56%, n = 47) who were discharged with cardiogenic pulmonary oedema as a diagnosis.
Clinical, biochemical and echocardiographic variables were collected and analysed. The completeness of two- and
five-year follow-up was 100% and 96%, respectively.
Results: The median (IQR) age was 74 years (64–81), left ventricular ejection fraction was 35% (27–45), blood pressure on
admission was 140/90 mm Hg (115–180/70–100), estimated glomerular filtration rate was 60 mL/min/1.73 m2 (45–73). Forty
per cent (n = 34) of the patients had a history of atrial fibrillation (AF), however, AF was directly involved with pulmonary
oedema only in 4% (n = 3) of the cases. Acute myocardial infarction (AMI) accounted for 34% (n = 29) of all the causes of
pulmonary oedema and was associated with a better two-year prognosis compared to other causes of pulmonary oedema
(p = 0.018). Two- and five-year mortality was 45% (n = 38) and 72% (n = 58), respectively. Co-morbidities were common.
Ischaemic heart disease and arterial hypertension were present in 83% and 70% of the patients, respectively. Multivariable
analysis identified increased left ventricular mass (RR 3.609, 95% CI 1.235–10.547, p = 0.017) and treatment with long-acting
vasodilator drugs (LAVDs) (RR 4.881, 95% CI 1.618–14.727, p = 0.004) as independent negative prognostic factors, whereas
in-hospital therapy with beta-blockers created a distinctly protective effect (RR 0.123, 95% CI 0.033–0.457, p = 0.002) in the
two-year follow-up. Five-year mortality was independently associated with older age (RR 1.08, 95% CI 1.02–1.14, p = 0.005)
and treatment with LAVDs (RR 6.4, 95% CI 1.47–28.14, p = 0.012), while percutaneous coronary intervention (RR 0.17,
95% CI 0.05–0.58, p = 0.004) significantly decreased the risk.
Conclusions: AHF is a heterogeneous syndrome with a very high remote mortality. LAVDs administered during the hospital
stay as well as older age on admission correlate with higher long-term overall mortality. In the age of percutaneous coronary
intervention, AMI aetiology of pulmonary oedema is no longer a negative prognostic factor for the long-term prognosis.
Aim: To investigate the long term prognosis and identify prognostic factors among patients who were discharged after an
episode of cardiogenic pulmonary oedema.
Methods: We enrolled 84 patients (M: 56%, n = 47) who were discharged with cardiogenic pulmonary oedema as a diagnosis.
Clinical, biochemical and echocardiographic variables were collected and analysed. The completeness of two- and
five-year follow-up was 100% and 96%, respectively.
Results: The median (IQR) age was 74 years (64–81), left ventricular ejection fraction was 35% (27–45), blood pressure on
admission was 140/90 mm Hg (115–180/70–100), estimated glomerular filtration rate was 60 mL/min/1.73 m2 (45–73). Forty
per cent (n = 34) of the patients had a history of atrial fibrillation (AF), however, AF was directly involved with pulmonary
oedema only in 4% (n = 3) of the cases. Acute myocardial infarction (AMI) accounted for 34% (n = 29) of all the causes of
pulmonary oedema and was associated with a better two-year prognosis compared to other causes of pulmonary oedema
(p = 0.018). Two- and five-year mortality was 45% (n = 38) and 72% (n = 58), respectively. Co-morbidities were common.
Ischaemic heart disease and arterial hypertension were present in 83% and 70% of the patients, respectively. Multivariable
analysis identified increased left ventricular mass (RR 3.609, 95% CI 1.235–10.547, p = 0.017) and treatment with long-acting
vasodilator drugs (LAVDs) (RR 4.881, 95% CI 1.618–14.727, p = 0.004) as independent negative prognostic factors, whereas
in-hospital therapy with beta-blockers created a distinctly protective effect (RR 0.123, 95% CI 0.033–0.457, p = 0.002) in the
two-year follow-up. Five-year mortality was independently associated with older age (RR 1.08, 95% CI 1.02–1.14, p = 0.005)
and treatment with LAVDs (RR 6.4, 95% CI 1.47–28.14, p = 0.012), while percutaneous coronary intervention (RR 0.17,
95% CI 0.05–0.58, p = 0.004) significantly decreased the risk.
Conclusions: AHF is a heterogeneous syndrome with a very high remote mortality. LAVDs administered during the hospital
stay as well as older age on admission correlate with higher long-term overall mortality. In the age of percutaneous coronary
intervention, AMI aetiology of pulmonary oedema is no longer a negative prognostic factor for the long-term prognosis.
Keywords: acute heart failurecardiogenic pulmonary oedemarisk factors
