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

Table 1 Baseline demographic, clinical, and echocardiographic characteristics of the study cohort (n = 28)

Variable	Total (n = 28)	Survivors (n = 24)	Non-survivors (n = 4)	P value
Age (years)	73.82 ± 12.14	74.12 ± 11.68	72.00 ± 16.57	0.819
Male sex, %	61.9	64.7	50.0	0.618
Smoking, %	21.4	20.8	25.0	1.000
Hypertension, %	100.0	100.0	100.0	1.000
Dyslipidemia, %	96.4	100.0	75.0	0.143
Obesity, %	29.6	30.4	25.0	1.000
Diabetes mellitus, %	53.6	50.0	75.0	0.600
Valvular heart disease, %	71.4	75.0	50.0	0.555
Systolic BP (mmHg)	173.39 ± 38.52	172.58 ± 39.94	178.25 ± 33.05	0.772
Diastolic BP (mmHg)	99.39 ± 21.23	99.75 ± 22.59	97.25 ± 11.70	0.746
Heart rate (bpm)	105.61 ± 23.04	105.75 ± 24.69	104.75 ± 10.24	0.892
NT-proBNP (pg/mL)	10513.96 ± 10381.23	9955.83 ± 10293.27	13862.75 ± 11840.24	0.569
TAPSE (mm)	22.61 ± 8.20	23.29 ± 8.61	18.50 ± 3.32	0.072
LVOT VTI (cm)	16.20 ± 4.52	16.03 ± 4.72	17.23 ± 3.34	0.561
RV-RA gradient (mmHg)	28.93 ± 9.74	29.00 ± 10.51	28.50 ± 2.65	0.845
LVEF (%)	38.68 ± 15.42	38.83 ± 15.07	37.75 ± 19.92	0.923

Continuous variables are presented as mean ± SD, and categorical variables as percentages. Comparisons between survivors and non-survivors were performed using the Student’s t-test or Mann-Whitney U test, as appropriate, for continuous variables, and the χ² test or Fisher’s exact test for categorical variables. A two-sided P value < 0.05 was considered statistically significant. Valvular heart disease: ≥ moderate dysfunction of any cardiac valve. BP: Blood pressure; LVOT VTI: Left ventricular outflow tract velocity-time integral; LVEF: Left ventricular ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide; RV-RA: Right ventricular to right atrial pressure gradient; TAPSE: Tricuspid annular plane systolic excursion.

Table 2 Comparison of echocardiographic parameters between survivors and non-survivors with cardiogenic pulmonary edema

Parameter	Survivors, median (IQR)	Non-survivors, median (IQR)	P value
E/E’	11.37 (10.15-14.33)	15.41 (12.70-18.17)	0.291
TAPSE	20.00 (17.75-26.25)	19.00 (17.75-19.75)	0.323
S RV	12.00 (10.00-13.20)	10.00 (8.25-11.75)	0.339
S LV	6.90 (5.97-7.62)	6.75 (6.12-7.12)	0.669
S LV/S RV	0.60 (0.50-0.71)	0.73 (0.59-0.83)	0.533
LVEF	37.50 (26.75-47.25)	38.00 (20.75-55.00)	0.844
LVOT VTI	16.00 (13.38-18.25)	17.00 (14.72-19.50)	0.645

Continuous variables are presented as median and interquartile range. Comparisons between groups were performed using the Mann-Whitney U test due to non-normal data distribution. A two-sided P value < 0.05 was considered statistically significant. E/E’ is ratio of early mitral inflow velocity to early diastolic mitral annular velocity. LVEF: Left ventricular ejection fraction; S LV: Systolic velocity of the lateral mitral annulus; S RV: Systolic velocity of the lateral tricuspid annulus; TAPSE: Tricuspid annular plane systolic excursion; LVOT VTI: Left ventricular outflow tract velocity-time integral; IQR: Interquartile range.

Table 3 Echocardiographic parameters according to ventilatory support requirements (n = 28)

Parameter	No ventilation, median (IQR)	NIV, median (IQR)	IMV, median (IQR)	P value
TAPSE	19.00 (15.75-28.00)	20.00 (17.50-24.00)	20.50 (17.75-23.25)	0.916
S RV	12.35 (10.50-13.60)	11.70 (9.00-12.20)	11.45 (9.75-12.43)	0.483
S LV	6.70 (5.83-8.20)	7.00 (6.00-7.75)	6.75 (6.12-7.05)	0.683
S LV/S RV	0.62 (0.48-0.73)	0.62 (0.52-0.80)	0.62 (0.57-0.69)	0.865
RV-RA gradient	31.0 (17.75-40.25)	29.0 (21.50-34.50)	29.5 (26.75-35.50)	0.816
E/E’	12.29 (10.89-15.48)	11.44 (9.97-13.92)	13.61 (9.85-18.17)	0.680
LVOT VTI	16.40 (13.55-21.75)	15.00 (13.50-18.50)	15.75 (14.72-17.62)	0.800
LVEF	38.0 (27.25-54.00)	38.0 (30.50-45.00)	28.0 (20.75-40.00)	0.580

Continuous variables are presented as median and interquartile range. Patients were categorized into three groups: No ventilatory support, non-invasive ventilation, and invasive mechanical ventilation. Comparisons across groups were performed using the Kruskal-Wallis test. A two-sided P value < 0.05 was considered statistically significant. E/E’: Ratio of early mitral inflow velocity to early diastolic mitral annular velocity; RV-RA gradient: Right ventricle-right atrium systolic pressure gradient; IMV: Invasive mechanical ventilation; LVEF: Left ventricular ejection fraction; LVOT VTI: Left ventricular outflow tract velocity-time integral; NIV: Non-invasive ventilation; S LV: Systolic velocity of the lateral mitral annulus; S RV: Systolic velocity of the lateral tricuspid annulus; IQR: Interquartile range.

Table 4 Spearman correlation analysis between echocardiographic parameters and intensive care unit length of stay

Parameter	Spearman ρ	P value
TAPSE	-0.148	0.444
S RV	-0.078	0.686
S LV	-0.189	0.326
S LV/S RV	-0.001	0.995
RV-RA gradient	-0.055	0.777
E-wave	0.175	0.363
E/E’	0.198	0.302
LVOT VTI	0.031	0.874
LVEF	-0.175	0.365

Spearman’s rank correlation coefficient (ρ) was used to assess the association between echocardiographic parameters and duration of intensive care unit stay. A two-sided P value < 0.05 was considered statistically significant. E/E’ is ratio of early mitral inflow velocity to early diastolic mitral annular velocity. E-wave: Peak early mitral inflow velocity; RV-RA gradient: Right ventricle-right atrium systolic pressure gradient; LVEF: Left ventricular ejection fraction (biplane Simpson method); LVOT VTI: Left ventricular outflow tract velocity-time integral; S LV: Systolic velocity of the lateral mitral annulus; S RV: Systolic velocity of the lateral tricuspid annulus; TAPSE: Tricuspid annular plane systolic excursion.

Table 5 Echocardiographic parameters according to inotropic support requirement

Parameter	No inotrope, median (IQR)	Inotrope, median (IQR)	P value
E/E’	12.02 (10.62-14.33)	13.61 (9.38-18.17)	0.874
TAPSE (mm)	19.50 (17.75-26.25)	19.50 (17.75-20.50)	0.448
S RV (cm/second)	12.00 (10.00-13.20)	10.00 (8.25-11.75)	0.339
S LV (cm/second)	6.90 (5.97-7.50)	6.75 (6.12-8.00)	0.973
S LV/S RV	0.60 (0.50-0.71)	0.73 (0.59-0.93)	0.393
LVEF (%)	38.50 (26.75-52.00)	29.50 (20.75-42.25)	0.449
LVOT VTI (cm)	16.20 (13.38-19.00)	14.50 (13.97-16.50)	0.792

Continuous variables are presented as median and interquartile range. Patients were classified according to the need for inotropic support during hospitalization (no inotropic support vs inotropic support). Comparisons between groups were performed using the Mann-Whitney U test. A two-sided P value < 0.05 was considered statistically significant. E/E’ is ratio of early mitral inflow velocity to early diastolic mitral annular velocity. LVEF: Left ventricular ejection fraction (biplane Simpson method); LVOT VTI: Left ventricular outflow tract velocity-time integral; S LV: Systolic velocity of the lateral mitral annulus; S RV: Systolic velocity of the lateral tricuspid annulus; TAPSE: Tricuspid annular plane systolic excursion; IQR: Interquartile range.