José Luis Morales-Rull1, Silvia Bielsa2, Alicia Conde-Martel3, Oscar Aramburu-Bodas4, Pau Llàcer5, Miguel Angel Quesada6, Iván Suárez-Pedreira7, Luis Manzano8, Manuel Montero-Pérez Barquero9, José M Porcel10. 1. Heart Failure Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain. 2. Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain. 3. Department of Internal Medicine, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain. 4. Department of Internal Medicine, Virgen de la Macarena University Hospital, Sevilla, Spain. 5. Department of Internal Medicine, Manises Hospital, Valencia, Spain. 6. Department of Internal Medicine, La Paz University Hospital, Madrid, Spain. 7. Department of Internal Medicine, Valle del Nalón Hospital, Asturias, Spain. 8. Department of Internal Medicine, Ramón y Cajal University Hospital, University of Alcalá (IRYCIS), Madrid, Spain. 9. Department of Internal Medicine, IMIBIC/Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain. 10. Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain. Electronic address: jmporcel.lleida.ics@gencat.cat.
Abstract
BACKGROUND: The incidence of pleural effusions (PEs) in acute decompensated heart failure (ADHF) is not well established. We aimed to determine their prevalence, clinical characteristics and prognostic implications. METHODS: Retrospective review of 3245 consecutive patients with ADHF from the Spanish RICA Registry. The clinical characteristics of those with or without PEs on chest radiographs were compared and a predictive PE model was generated. RESULTS: Patient's median age was 80 years and 60% had a left ventricular ejection fraction (LVEF) >50%. PEs were seen in 46% of the cases, and their distribution was as follows: 58% bilateral, 27% right-sided and 14% left-sided. Male gender (OR 2.18; 95%CI 1.23-3.87), serum amino-terminal fraction of the pro-brain natriuretic peptide (NT-pro-BNP) levels >3500 pg/ml (OR 2.2; 95%CI 1.25-3.77), estimated systolic pulmonary artery pressure (sPAP) >55 mm Hg by echocardiography (OR 2.05; 95%CI 1.12-3.75), and serum prealbumin <15 mg/l (OR 1.96; 95%CI 1.08-3.52) were associated with PE development in a multivariate analysis. Serum NT-proBNP >8000 pg/ml, and systolic arterial pressure <110 mm Hg, but not PEs, independently predicted overall 1-year mortality. CONCLUSIONS: PEs are present on chest radiographs in nearly half of ADHF patients. They are mainly bilateral or right-sided and predominate in males with elevated sPAP on echocardiography and high serum levels of NT-proBNP. PEs do not independently predict 1-year mortality.
BACKGROUND: The incidence of pleural effusions (PEs) in acute decompensated heart failure (ADHF) is not well established. We aimed to determine their prevalence, clinical characteristics and prognostic implications. METHODS: Retrospective review of 3245 consecutive patients with ADHF from the Spanish RICA Registry. The clinical characteristics of those with or without PEs on chest radiographs were compared and a predictive PE model was generated. RESULTS:Patient's median age was 80 years and 60% had a left ventricular ejection fraction (LVEF) >50%. PEs were seen in 46% of the cases, and their distribution was as follows: 58% bilateral, 27% right-sided and 14% left-sided. Male gender (OR 2.18; 95%CI 1.23-3.87), serum amino-terminal fraction of the pro-brain natriuretic peptide (NT-pro-BNP) levels >3500 pg/ml (OR 2.2; 95%CI 1.25-3.77), estimated systolic pulmonary artery pressure (sPAP) >55 mm Hg by echocardiography (OR 2.05; 95%CI 1.12-3.75), and serum prealbumin <15 mg/l (OR 1.96; 95%CI 1.08-3.52) were associated with PE development in a multivariate analysis. Serum NT-proBNP >8000 pg/ml, and systolic arterial pressure <110 mm Hg, but not PEs, independently predicted overall 1-year mortality. CONCLUSIONS: PEs are present on chest radiographs in nearly half of ADHF patients. They are mainly bilateral or right-sided and predominate in males with elevated sPAP on echocardiography and high serum levels of NT-proBNP. PEs do not independently predict 1-year mortality.
Authors: Rachel M Mercer; John P Corcoran; Jose M Porcel; Najib M Rahman; Ioannis Psallidas Journal: Clin Med (Lond) Date: 2019-05 Impact factor: 2.659
Authors: Moritz Lindner; Richard Thomas; Brian Claggett; Eldrin F Lewis; John Groarke; Allison A Merz; Montane B Silverman; Varsha Swamy; Jose Rivero; Christian Hohenstein; Scott D Solomon; John Jv McMurray; Michael L Steigner; Elke Platz Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-01-24