ATRIAL FIBRILLATION DOUBLED IN-HOSPITAL MORTALITY IN 1379 ACUTE CARDIOGENIC PULMONARY EDEMA PATIENTS

Abstract

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