Left and right ventricular echocardiographic patterns in cardiogenic pulmonary edema: An exploratory retrospective study

doi:10.4330/wjc.121228

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Cardiol. Jul 26, 2026; 18(7): 121228
Published online Jul 26, 2026. doi: 10.4330/wjc.121228

Left and right ventricular echocardiographic patterns in cardiogenic pulmonary edema: An exploratory retrospective study

Dan Cristian Popescu, Mara Diaconu, Diana Țînț, Alexandru Cristian Nechita

Dan Cristian Popescu, Mara Diaconu, Alexandru Cristian Nechita, Department of Cardiology, Clinical Emergency Hospital “Sfântul Pantelimon”, Bucharest 021652, București, Romania

Diana Țînț, Department of Medical and Surgical Specialties, Faculty of Medicine, “Transilvania” University, Brasov 500019, Brasov, Romania

Author contributions: Popescu DC and Țînț D conceived and designed the study; Popescu DC performed data curation and formal analysis; Popescu DC and Nechita AC conducted the investigation; Popescu DC and Diaconu M developed the study methodology; Țînț D supervised the work; Popescu DC drafted the manuscript; Diaconu M, Țînț D, and Nechita AC critically revised the manuscript; and all authors reviewed the manuscript critically, approved the final version, and agreed to submit it for publication.

AI contribution statement: During the preparation of this manuscript, the authors used ChatGPT (version GPT-5.1, OpenAI, San Francisco, CA, United States) for language polishing and to assist in generating graphical representations of the study data. No AI tool was involved in the study design, data collection, statistical analysis, interpretation of results, formulation of conclusions, or preparation of the references. All AI-assisted outputs were critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the final manuscript. The authors used ChatGPT (version GPT-5.1, OpenAI, San Francisco, CA, United States) to assist in generating the graphical representations of the study data included in all figures. All AI-assisted graphical content was reviewed, verified, and approved by the authors, who take full responsibility for the accuracy, originality, and integrity of the final figures.

Institutional review board statement: As stated in the Methods section, the study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Emergency Clinical Hospital “Sf. Pantelimon”, Bucharest (Approval No. 77/09.09.2024).

Informed consent statement: Patient consent was waived due to the retrospective design of the study, which was based exclusively on anonymized medical records, with no direct patient contact and no collection of identifiable personal data. According to institutional policy and national regulations, written informed consent was not required for this type of retrospective analysis.

Conflict-of-interest statement: The authors declare no conflict of interest.

Data sharing statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to patient privacy and confidentiality restrictions.

Corresponding author: Diana Țînț, Professor, Department of Medical and Surgical Specialties, Faculty of Medicine, “Transilvania” University, Nicolae Balcescu, No. 56, Brasov 500019, Brasov, Romania. diana.tint@unitbv.ro

Received: March 27, 2026
Revised: April 19, 2026
Accepted: June 18, 2026
Published online: July 26, 2026
Processing time: 121 Days and 6.7 Hours

Abstract

BACKGROUND

Cardiogenic pulmonary edema (CPE) is a severe manifestation of acute heart failure (AHF), typically driven by elevated left ventricular (LV) filling pressures. Although LV dysfunction has traditionally been emphasized, right ventricular (RV) function and biventricular interaction may also contribute to the hemodynamic profile of acute decompensation.

AIM

To describe the clinical and echocardiographic profile of patients with CPE and to explore associations between left and RV echocardiographic parameters and the in-hospital course.

METHODS

We retrospectively analyzed 28 patients with CPE from a larger AHF registry, excluding those with incomplete echocardiographic data or missing N-terminal pro-B-type natriuretic peptide measurement. Comprehensive echocardiographic assessment at admission included tricuspid annular plane systolic excursion, RV systolic annular velocity, RV-right atrial gradient, LV ejection fraction, LV outflow tract velocity-time integral, LV systolic annular velocity, mitral E velocity, and E/E’ ratio. Clinical variables, N-terminal pro-B-type natriuretic peptide levels, and in-hospital variables, including mortality, ventilatory support, inotropic support, and intensive care unit stay, were recorded. Group comparisons, correlation analyses, and exploratory receiver operating characteristic curve analyses were performed.

RESULTS

The mean LV systolic annular velocity was significantly lower than the RV systolic annular velocity (7.34 ± 2.38 cm/second vs 11.49 ± 2.70 cm/second; P < 0.001). Four patients (14.3%) died during hospitalization. No echocardiographic parameter showed a statistically significant association with in-hospital mortality. Exploratory analyses showed numerical differences in mitral E velocity, ventricular systolic velocities, and the ratio of LV to RV systolic annular velocity across in-hospital severity measures, but these findings were not statistically significant.

CONCLUSION

In this small retrospective cohort of patients with CPE, LV systolic annular velocity was lower than RV systolic annular velocity at presentation, while no echocardiographic parameter showed a significant association with in-hospital mortality. These findings should be considered exploratory and hypothesis-generating and require confirmation in larger prospective studies.

Keywords: Cardiogenic pulmonary edema; Acute heart failure; Echocardiography; Right ventricular function; Left ventricular function; Left ventricular outflow tract velocity-time integral; E/E’ ratio; Mortality

Core Tip: This single-center retrospective exploratory study describes the clinical and echocardiographic profile of patients presenting with cardiogenic pulmonary edema, with particular focus on left and right ventricular systolic function. Admission echocardiographic parameters were examined in relation to the in-hospital course, including mortality, ventilatory support, inotropic support, and intensive care unit stay. In this small cohort, left ventricular systolic annular velocity was significantly lower than right ventricular systolic annular velocity, whereas no echocardiographic parameter showed a significant association with in-hospital mortality. These findings should be interpreted cautiously and considered hypothesis-generating.