Goran Koraćević, Ružica Janković–Tomašević, Emina Dimitrijević, Aleksandar Stojković, Slađana Petrović, Milan Pavlović, Miodrag Damjanović, Tomislav Kostić, Tatjana Đerić, Marija Kutlešić

DOI Number
First page
Last page


Medical significance of heart failure (HF) is obvious; it results from high prevalence, morbidity and mortality rate. Acute cardiogenic pulmonary edema (ACPE) is an emergency, the most severe retrograde left ventricular (LV) insufficiency. PubMed search revealed not a single paper with the objective to evaluate atrial fibrillation (AF) prevalence and prognostic significance in ACPE patients. Given the lack of information on the clinically very relevant topic, the aim of the study was to analyze prevalence, pathophysiologic consequences and possible prognostic significance of AF in ACPE. We studied homogenous group of 1397 ACPE patients, including those in cardiogenic shock, but without concomitant acute myocardial infarction (AMI). Prevalence of AF in ACPE was 29.74%. Intra-hospital mortality of ACPE patients with AF was 20.05% vs. 12.85% in patients without AF (p=0.00078). In conclusion, prevalence of AF is very high in the largest published homogenous acute cardiogenic pulmonary edema series (without AMI). Pathophysiologic mechanisms of AF-induced clinical course detrimental effects include impairment of left ventricle function (even critically), as well as induction / worsening of ischemia, etc. AF is associated with (almost) doubled mortality in acute cardiogenic pulmonary edema. AF was a better predictor of in-hospital mortality then LV ejection fraction, diabetes mellitus, and many others.

Key words: Acute cardiogenic pulmonary edema, heart failure, atrial fibrillation, pulse pressure, prognosis

Full Text:



McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14:803–869.

O'Meara E, Thibodeau-Jarry N, Ducharme A, Rouleau JL. The epidemic of heart failure: a lucid approach to stemming the rising tide. Can J Cardiol 2014; 30:S442–454.

Schmickl CN, Biehl M, Wilson GA, Gajic O. Comparison of hospital mortality and long-term survival in patients with acute lung injury/ARDS vs cardiogenic pulmonary edema. Chest 2015; 147:


Marcinkiewicz M, Ponikwicka K, Szpakowicz A, Musiał WJ, Kamiński KA. Cardiogenic pulmonary oedema: alarmingly poor long term prognosis. Analysis of risk factors. Kardiol Pol 2013; 71:712–720.

Konishi M, Matsuzawa Y, Suzuki H, et al. Higher level at admission and subsequent decline in hemoglobin in patients with acute pulmonary edema. Circ J 2014; 78:896–902.

January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64:e1–76.

Koracevic G, Cvetkovic E, Tomasevic M, et al. Atrial fibrillation doubled in-hospital mortality in 1397 acute cardiogenic pulmonary edema patients. Circulation 2010; 122:669.

Abusada K, Sharma SB, Jaladi R, Ezekowity MD. Epidemiology and management of new-onset atrial fibrillation. Am J Manag Care 2004; 10:s50–57.

Gallagher M, Camm J. Classification of atrial fibrillation. Am J Cardiol 1998; 82:18N–28N.

Kannel W, Wolf P, Benjamin E, Levy D. Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998; 82:2N–9N.

Potpara TS, Polovina MM, Licina MM, Marinkovic JM, Lip GY. Predictors and prognostic implications of incident heart failure following the first diagnosis of atrial fibrillation in patients with structurally normal heart: the Belgrade atrial fibrilation study. Eur J Heart Fail 2013; 15:415–424.


  • There are currently no refbacks.

© University of Niš, Serbia
Creative Commons licence CC BY-NC-ND
ISSN 0354-4699 (Print)
ISSN 2406-050X (Online)