The prognostic value of right ventricule and pulmonary vascular resistance in non acute coronary syndrome acute pulmonary edema

Introduction: Ventricular interdependence, the ri-ght ventricle (RV) function and pulmonary vascular resistance(PVR) 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 Co-ronary Syndromes(ACS) associeted with left ventricu-lar dysfunction. What about the RV role in APE outsi-de of ACS?
Objective: To study the prognostic role of the RV and PVR in patients with non-ACS APE and the correlati-on of the RV eco parameters with the early outcomes, in relation with ethiology.
Methods: Ninety two 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 hypertensi-ve (with preserved LVEF, without significant valvular or documented coronary artery disease). An echocar-diography 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 gra-dient (RA-RV PG).We identified the correlation of the-se parameters with in hospital mortality(IHM) in the entire group and according with underlying ethiology. Results: In the whole group of patients all 3 parameters, in a univariate analysis, were statistically significant associated with IHM (p<0.01) with the following cutt of values (COV) at ROC curve: TAPSE <17 mm (p<0.01), PAT <92 ms (p<0.01), RA-RV PG >41 mmHg (p<0.01). The prognostic value has been changed when was correleted with ethiology. Remained SS for hyper-tensive 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 <17 mm) and pulmonary hyper-tension (PAT <92 ms and RA-RV PG >41 mmHg) 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 im-portant in APE patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)