Quantification of pleural effusions on thoracic ultrasound in acute heart failure.

Autor:	Lindner M; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.; Friedrich-Schiller-University Jena, Germany., Thomas R; Department of Radiology, Brigham and Women's Hospital, Boston, USA.; Harvard Medical School, Boston, USA., Claggett B; Harvard Medical School, Boston, USA.; Cardiovascular Division, Brigham and Women's Hospital, Boston, USA., Lewis EF; Harvard Medical School, Boston, USA.; Cardiovascular Division, Brigham and Women's Hospital, Boston, USA., Groarke J; Harvard Medical School, Boston, USA.; Cardiovascular Division, Brigham and Women's Hospital, Boston, USA., Merz AA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.; Harvard Medical School, Boston, USA., Silverman MB; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.; Harvard Medical School, Boston, USA., Swamy V; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.; Harvard Medical School, Boston, USA., Rivero J; Harvard Medical School, Boston, USA.; Cardiovascular Division, Brigham and Women's Hospital, Boston, USA., Hohenstein C; Department of Emergency Medicine, University Hospital Magdeburg, Germany., Solomon SD; Harvard Medical School, Boston, USA.; Cardiovascular Division, Brigham and Women's Hospital, Boston, USA., McMurray JJ; BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK., Steigner ML; Department of Radiology, Brigham and Women's Hospital, Boston, USA.; Harvard Medical School, Boston, USA., Platz E; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.; Harvard Medical School, Boston, USA.
Jazyk:	angličtina
Zdroj:	European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2020 Aug; Vol. 9 (5), pp. 513-521. Date of Electronic Publication: 2020 Jan 24.
DOI:	10.1177/2048872620901835
Abstrakt:	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.
Databáze:	MEDLINE
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