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Pleural effusions in acute decompensated heart failure: Prevalence and prognostic implications

Published:February 07, 2018DOI:https://doi.org/10.1016/j.ejim.2018.02.004

      Highlights

      • The incidence of PEs in patients with ADHF reaches nearly 50%.
      • Isolated right and left-sided PEs are not an atypical finding in ADHF.
      • Male gender, sPAP, serum prealbumin and serum NT-pBNP were associated with PE development.
      • PEs might be an indicator of pulmonary hypertension and right HF.
      • PEs are not an independent predictor of 1-year mortality in ADHF.

      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.

      Keywords

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      References

        • Porcel J.M.
        • Vives M.
        Distribution of pleural effusion in congestive heart failure.
        South Med J. 2006; 99: 98-99
        • Abouezzeddine O.F.
        • Redfield M.M.
        Who has advanced heart failure? Definition and epidemiology.
        Congest Heart Fail. 2011; 17: 160-168
        • McKee P.A.
        • Castelli W.P.
        • McNamara P.M.
        • Kannel W.B.
        The natural history of congestive heart failure: the Framingham study.
        N Engl J Med. 1971; 285: 1441-1446
        • Woodring J.H.
        Distribution of pleural effusion in congestive heart failure: what is atypical?.
        South Med J. 2005; 98: 518-523
        • Kataoka H.
        Ultrasound pleural effusion sign as a useful marker for identifying heart failure worsening in established heart failure patients during follow-up.
        Congest Heart Fail. 2012; 18: 272-277
        • Steg P.G.
        • Joubin L.
        • McCord J.
        • Abraham W.T.
        • Hollander J.E.
        • Omland T.
        • et al.
        B-type natriuretic peptide and echocardiographic determination of ejection fraction in the diagnosis of congestive heart failure in patients with acute dyspnea.
        Chest. 2005; 128: 21-29
        • Trullàs J.C.
        • Formiga F.
        • Montero M.
        • Conde A.
        • Casado J.
        • Carrasco F.J.
        • et al.
        Paradoja de la obesidad en la insuficiencia cardiaca. Resultados del Registro RICA.
        Med Clin (Barc). 2011; 137: 671-677
        • Perez-Calvo J.I.
        • Montero-Perez-Barquero M.
        • Camafort-Babkowski M.
        • Conthe-Gutierrez P.
        • Formiga F.
        • Aramburu-Bodas O.
        • et al.
        Influence of admission blood pressure on mortality in patients with acute decompensated heart failure.
        QJM. 2011; 104: 325-333
        • Dickstein K.
        • Cohen-Solal A.
        • Filippatos G.
        • McMurray J.J.V.
        • Ponikowski P.
        • Poole-Wilson P.A.
        • et al.
        ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).
        Eur Heart J. 2008; 29: 2388-2442
        • Authors/Task Force Members
        • JJV McMurray
        • Adamopoulos S.
        • Anker S.D.
        • Auricchio A.
        • Bohm M.
        • et al.
        ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2012; 33: 1787-1847
        • Porcel J.M.
        • Esquerda A.
        • Vives M.
        • Bielsa S.
        Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses.
        Arch Bronconeumol. 2014; 50: 161
        • Porcel J.M.
        • Light R.W.
        • Effusions Pleural
        Dis Mon. 2013; 59: 29-57
        • Claret P.G.
        • Stiell I.G.
        • Yan J.W.
        • Clement C.M.
        • Rowe B.H.
        • Calder L.A.
        • et al.
        Characteristics and outcomes for acute heart failure in elderly patients presenting to the ED.
        Am J Emerg Med. 2016; 34: 2159-2166
        • Kataoka H.
        • Takada S.
        The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure.
        J Am Coll Cardiol. 2000; 35: 1638-1646
        • Trullàs J.C.
        • Miró Ò.
        • Formiga F.
        • Martín-Sánchez F.J.
        • Montero-Pérez-Barquero M.
        • Jacob J.
        • et al.
        The utility of heart failure registries: a descriptive and comparative study of two heart failure registries.
        Postgrad Med J. 2016; 92: 260-266
        • Brixey A.G.
        • Light R.W.
        Pleural effusions occurring with right heart failure.
        Curr Opin Pulm Med. 2011; 17: 226-231
        • Januzzi J.L.
        Natriuretic peptides as biomarkers in heart failure.
        J Invest Med. 2013; 61: 950-955
        • Kolditz M.
        High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions.
        Eur Respir J. 2006; 28: 144-150
        • Tomcsányi J.
        • Nagy E.
        • Somlói M.
        • Moldvay J.
        • Bezzegh A.
        • Bózsik B.
        • et al.
        NT-brain natriuretic peptide levels in pleural fluid distinguish between pleural transudates and exudates.
        Eur J Heart Fail. 2004; 6: 753
        • Han C.H.
        • Choi J.E.
        • Chung J.H.
        Clinical utility of pleural fluid NT-probrain natriuretic peptide (NT-proBNP) in patients with pleural effusions.
        Intern Med. 2008; 47: 1669-1674
        • Bayram M.
        • Ozkan G.
        • Oztekin E.
        • Bakan N.D.
        • Acikmese B.
        • Bes S.
        • et al.
        Role of serum and pleural fluid NT-proBNP levels in identifying pleural effusion due to heart failure.
        Multidiscip Respir Med. 2009; 4: 175-181
        • Porcel J.M.
        • Chorda J.
        • Cao G.
        • Esquerda A.
        • Ruiz-González A.
        • Vives M.
        Comparing serum and pleural fluid pro-brain natriuretic peptide (NT-proBNP) levels with pleural-to-serum albumin gradient for the identification of cardiac effusions misclassified by Light's criteria.
        Respirology. 2007; 12: 654-659
        • Grodin J.L.
        • Drazner M.H.
        • Dupont M.
        • Mullens W.
        • Taylor D.O.
        • Starling R.C.
        • et al.
        A disproportionate elevation in right ventricular filling pressure, in relation to left ventricular filling pressure, is associated with renal impairment and increased mortality in advanced decompensated heart failure.
        Am Heart J. 2015; 169: 806-812