HF vs NIV in Acute Cardiogenic Pulmonary Edema

Inclusion Criteria: * Age ≥ 18 y.o.; * Clinical diagnosis of ACPE in the setting of either AMI, acute myocarditis, acute/chronic severe mitral/aortic valve regurgitation, severe mitral/aortic stenosis, acute/chronic HF with rLVEF diagnosed according to European Society of Cardiology (ESC) guidelines \[4\]; * Hypertensive crisis with systolic blood pressure \>200 mmHg; * Other congenital or acquired structural heart disease causing post capillary pulmonary hypertension or combination of the previous. * Written informed consent. Exclusion Criteria: * Age \<18 y.o.; * Hypercapnia with respiratory acidosis (PaCO2 \> 45 mmHg with pH \< 7.35); * History of fever in the previous 4 days; * White blood cell count \> 12.000; * Increased procalcitonin serum levels; * Consolidative areas at chest radiograph; * Hypotension (systolic blood pressure \< 85 mmHg); * Cardiogenic shock; * Right ventricular (RV) dysfunction; * Previous cardiac surgery, * Glasgow Coma Scale score ≤ 8 points; * Impaired ability to protect the airway from aspiration; * Orotracheal intubation needed due to cardiopulmonary resuscitation maneuvers; * Respiratory arrest; * Severe hemodynamic instability; * Facial trauma, burns, recent facial surgery or facial anatomy which prevents from the application of the NPPV interface to patient's face.