Prevalence, characteristics, and outcomes of patients presenting with cardiogenic unilateral pulmonary edema.
BACKGROUND
Cardiogenic unilateral pulmonary edema (UPE) is a rare entity, frequently leading to initial misdiagnosis. We sought to assess the prevalence of UPE and to determine its impact on prognosis compared with bilateral pulmonary edema.


RESULTS
We studied the characteristics and outcomes of patients admitted to our institution for cardiogenic pulmonary edema during an 8-year period. The study population included 869 consecutive patients. The prevalence of UPE was 2.1%: 16 right-sided UPE (89%) and 2 left-sided UPE (11%). In patients with UPE, blood pressure was significantly lower (P≤0.01), whereas noninvasive or invasive ventilation and catecholamines were used more frequently (P=0.0004 and P<0.0001, respectively). The prevalence of severe mitral regurgitation in patients with bilateral pulmonary edema and UPE was 6% and 100%, respectively (P<0.0001). In patients with UPE, use of antibiotic therapy and delay in treatment were significantly higher (P<0.0001 and P=0.003, respectively). In-hospital mortality was 9%: 39% for UPE versus 8% for bilateral pulmonary edema (odds ratio, 6.9; 95% confidence interval, 2.6 to 18; P<0.001). In multivariate analysis, unilateral location of pulmonary edema was independently related to death whatever the model used (adjusted odds ratio, 6.5; 95% confidence interval, 1.3 to 32; P=0.021 for model A; and adjusted odds ratio, 6.8; 95% confidence interval, 1.1 to 41; P=0.037 for model B).


CONCLUSIONS
Unilateral pulmonary edema represented 2.1% of cardiogenic pulmonary edema in our study, usually appeared as an opacity involving the right lung, and was always associated with severe mitral regurgitation. Unilateral pulmonary edema is related to an independent increased risk of mortality and should be promptly recognized to avoid delays in treatment.
Attias
David
D
Department of Cardiology, Université de Versailles-Saint Quentin, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne, France. david.attias@apr.aphp.fr
Mansencal
Nicolas
N
Auvert
Bertran
B
Vieillard-Baron
Antoine
A
Delos
Aurélie
A
Lacombe
Pascal
P
N'Guetta
Roland
R
Jardin
François
F
Dubourg
Olivier
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications*; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology