Loading...
Quantification of pleural effusions on thoracic ultrasound in acute heart failure
Lindner, Moritz Thomas, Richard Claggett, Brian Lewis, Eldrin F. Groarke, John Merz, Allison A. Silverman, Montane B. Swamy, Varsha Rivero, JoHohenstein, Christianse Solomon, Scott D.
Lindner, Moritz
Thomas, Richard
Claggett, Brian
Lewis, Eldrin F.
Groarke, John
Merz, Allison A.
Silverman, Montane B.
Swamy, Varsha
Rivero, JoHohenstein, Christianse
Solomon, Scott D.
Abstract
Background:
Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically.
Methods:
In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size.
Results:
Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score (P<0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography (P<0.001), higher NT-pro brain natriuretic peptide values (P=0.001) and a greater number of B-lines on lung ultrasound (P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92–1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11–5.37; P=0.027).
Conclusion:
Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.
Keywords
ultrasound, pleural effusion, acute heart failure
Date
2020
Type
Journal article
Journal
European Heart Journal: Acute Cardiovascular Care
Book
Volume
9
Issue
5
Page Range
513-521
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled