Echocardiographic Predictors of Clinical Outcomes in Cardiogenic Pulmonary Edema: Insights Into Ventricular Function and Intensive Care Requirements

Background: Cardiogenic pulmonary edema (CPE) is a severe manifestation of acute heart failure (AHF), typically driven by elevated left ventricular (LV) filling pressures. While LV dysfunction has been the traditional focus, growing evidence highlights the role of right ventricular (RV) impairment and biventricular interaction in the pathophysiology and prognosis of AHF. Objectives: To characterize the clinical and echocardiographic profile of patients presenting with CPE and to assess the comparative prognostic contribution of LV and RV function to in-hospital outcomes. Methods: We retrospectively analyzed 28 patients with CPE from a larger AHF registry, excluding those with incomplete echocardiographic data or missing NT-proBNP measurement. Comprehensive echocardiographic assessment at admission included TAPSE, S RV, RV–RA gradient, LVEF, LVOT VTI, S LV, and E/E′ ratio. Clinical variables, NT-proBNP levels, and in-hospital outcomes (mortality, ventilation, inotropic support, ICU stay) were recorded. Group comparisons, correlation analyses, and ROC curve assessments were performed. Results: The mean S LV was significantly lower than S RV (7.34 ± 2.38 cm/s vs. 11.49 ± 2.70 cm/s; p < 0.001), indicating predominant LV longitudinal systolic impairment. Four patients (14.3%) died during hospitalization. No echocardiographic parameter reached statistical significance for predicting mortality. Patients with higher mitral E velocity and reduced LV systolic velocities tended to have longer ICU hospitalization.Trends toward lower S RV and higher S LV/S RV ratio were noted in patients requiring inotropes. Conclusions: In CPE, LV longitudinal systolic function is more impaired than RV function at presentation. While single echocardiographic indices lacked strong prognostic discrimination in this small cohort, integrated assessment of LV and RV systolic performance alongside diastolic filling pressures may improve early risk stratification. These findings align with the conceptual framework of composite prognostic tools and warrant validation in larger prospective studies.