There are extensive records which have included patients with acute
heart failure (AHF), but specific studies about prognosis in acute
pulmonary edema (PE) are scarce and have enrolled a small number of patients. The objectives of this study were to evaluate the predictive factors of short-term evolution in patients with PE.
PATIENTS, MATERIALS AND METHODS: This was a prospective, two-center survey of 70 consecutive patients admitted for acute cardiogenic PE. The follow-up was performed one month after discharge. The composite endpoint was in-hospital death, and death of any cause or readmission for
heart failure (HF) at one month after discharge. Heart and lung tissue analysis was performed postmortem to identify morphological features of PE.
RESULTS: In-hospital mortality was 4.2%, another 14.2% died in the first month, and an additional 10% required
rehospitalization for HF. The characteristics significantly associated with end-point occurrence were: history of
kidney disease,
anemia,
diabetes mellitus, lack of prior
angiotensin-converting enzyme inhibitor÷angiotensin-receptor blocker treatment, lower systolic blood pressure (BP) at admission, lower diastolic BP at admission,
creatinine at admission and at discharge, an increase in
creatinine during stay, glomerular filtration rate at admission, serum
sodium at admission, decrease in serum
sodium during hospitalization, N-terminal prohormone of
brain natriuretic peptide (
NT-proBNP) at discharge, right ventricle fractional area change, left atrium volume index. We created a multiple logistic regression model and identified five prognostic factors: age, diabetes,
creatinine, diastolic BP, serum
sodium. This model correctly classified 48 (96%) patients without worsening and 13 (65%) patients with worsening, providing an overall accuracy of 87.1%. Necropsy was performed on five patients and fragments of left ventricle myocardium and lung were harvested for histopathological and immunohistochemical studies. The myocardium exhibited
fibrosis areas where the myocytes were completely or partially replaced by
collagen fibers. Lung tissue analysis revealed some case-to-case differences, but the common finding was alveoli size larger than normal, with the lumen completely or almost completely covered by an eosinophilic liquid.
CONCLUSIONS: