Prevalence, Characteristics, and Outcomes of Patients Presenting With Cardiogenic Unilateral Pulmonary Edema

Abstract

Background-Cardiogenic unilateral pulmonary edema (UPE) is a rare entity, frequently leading to initial misdiagnosis.We sought to assess the prevalence of UPE and to determine its impact on prognosis compared with bilateral pulmonary edema. Methods and Results-We studied the characteristics and outcomes of patients admitted to our institution for cardiogenic pulmonary edema during an 8-year period. The study population included 869 consecutive patients. The prevalence of UPE was 2.1%: 16 right-sided UPE (89%) and 2 left-sided UPE (11%). In patients with UPE, blood pressure was significantly lower (PՅ0.01), whereas noninvasive or invasive ventilation and catecholamines were used more frequently (Pϭ0.0004 and PϽ0.0001, respectively). The prevalence of severe mitral regurgitation in patients with bilateral pulmonary edema and UPE was 6% and 100%, respectively (PϽ0.0001). In patients with UPE, use of antibiotic therapy and delay in treatment were significantly higher (PϽ0.0001 and Pϭ0.003, respectively). In-hospital mortality was 9%: 39% for UPE versus 8% for bilateral pulmonary edema (odds ratio, 6.9; 95% confidence interval, 2.6 to 18; PϽ0.001). In multivariate analysis, unilateral location of pulmonary edema was independently related to death whatever the model used (adjusted odds ratio, 6.5; 95% confidence interval, 1.3 to 32; Pϭ0.021 for model A; and adjusted odds ratio, 6.8; 95% confidence interval, 1.1 to 41; Pϭ0.037 for model B). Conclusions-Unilateral pulmonary edema represented 2.1% of cardiogenic pulmonary edema in our study, usually appeared as an opacity involving the right lung, and was always associated with severe mitral regurgitation. Unilateral pulmonary edema is related to an independent increased risk of mortality and should be promptly recognized to avoid delays in treatment. (Circulation. 2010;122:1109-1115.)

Hospital and 4‐Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease

“…Nevertheless, in patients admitted to critical care areas—such as in our study—hospital mortality is higher (32%), at least in the only reported series that involved 199 patients 24. In our work, hospital mortality was somewhat lower (25%), but it was higher than in patients not admitted to critical care areas,7, 10, 18, 22, 23 likely because of the more severe respiratory and/or hemodynamic condition, as indicated by the high need for endotracheal intubation or inotropic agents (26% and 29%), respectively. Another possible explanation was the high proportion of de novo cases of APE (>80%), a fact that has also been associated with higher hospital mortality 20.…”

“…In patients with APE, in‐hospital mortality seems comparable to patients with acute heart failure ranging also from 7.4% to 17%,7, 10, 18, 22, 23 although in small and earlier reports,7, 18 mortality was higher (12% and 17%) than in larger, more recent studies (7.4%–9.6%) 10, 22, 23. Nevertheless, in patients admitted to critical care areas—such as in our study—hospital mortality is higher (32%), at least in the only reported series that involved 199 patients 24.…”

Unilateral cardiogenic pulmonary edema associated with acute mitral regurgitation

“…Attias et al . reported that unilateral pulmonary edema represents approximately 2% of cardiogenic pulmonary edema 3. The most common cause of unilateral pulmonary edema is severe mitral regurgitation, as in our two cases 3.…”

“…reported that unilateral pulmonary edema represents approximately 2% of cardiogenic pulmonary edema 3. The most common cause of unilateral pulmonary edema is severe mitral regurgitation, as in our two cases 3. Unilateral cardiogenic pulmonary edema is often misdiagnosed as pneumonia, aspiration, or alveolar hemorrhage 4.…”

“…A typical chest radiography finding is bilateral alveolar edema, also called “butterfly shadow” 1. In contrast, unilateral cardiogenic pulmonary edema is rare and often misdiagnosed as a respiratory disease, delaying the treatment of heart failure, resulting in high mortality 3. The mechanism underlying unilateral pulmonary edema is suggested to be the crosswise difference in pulmonary venous pressure due to the eccentricity of the mitral regurgitation jet 3.…”