Key result
Five chest computed tomography signs, most notably an enlarged heart (OR 20.38), were independently associated with acute heart failure in patients presenting to the emergency department with acute dyspnea.
Why the study?
Pulmonary congestion is a key component of heart failure detected by chest CT, but no guideline describes which CT signs are most associated with heart failure in patients with undifferentiated dyspnea.
Do specific chest computed tomography signs accurately detect acute heart failure in patients ≥ 50 years presenting with acute dyspnea?
Observational (n=232)
Blinded (radiologists and adjudicators)
No
Do specific chest computed tomography signs accurately detect acute heart failure in patients ≥ 50 years presenting with acute dyspnea?
Odds Ratio: 20.38 (95% CI 6.86–76.16)
Five specific chest CT signs can accurately identify acute heart failure in older patients presenting to the emergency department with acute dyspnea.
CT signs of congestion may aid HF diagnosis in acute dyspnea; leaves open optimal signs and requires prospective validation.
BACKGROUND: Pulmonary congestion is a key component of heart failure (HF) that chest computed tomography (CT) can detect. However, no guideline describes which of many anticipated CT signs are most associated with HF in patients with undifferentiated dyspnea. METHODS: In a prospective observational single-center study, we included consecutive patients ≥ 50 years admitted with acute dyspnea to the emergency department. Patients underwent immediate clinical examination, blood sampling, echocardiography, and CT. Two radiologists independently evaluated all images. Acute HF (AHF) was adjudicated by an expert panel blinded to radiology images. LASSO and logistic regression identified the independent CT signs of AHF. RESULTS: Among 232 patients, 102 (44%) had AHF. Of 18 examined CT signs, 5 were associated with AHF (multivariate odds ratio, 95% confidence interval): enlarged heart (20.38, 6.86-76.16), bilateral interlobular thickening (11.67, 1.78-230.99), bilateral pleural effusion (6.39, 1.98-22.85), and increased vascular diameter (4.49, 1.08-33.92). Bilateral ground-glass opacification (2.07, 0.95-4.52) was a consistent fifth essential sign, although it was only significant in univariate analysis. Eighty-eight (38%) patients had none of the five CT signs corresponding to a 68% specificity and 86% sensitivity for AHF, while two or more of the five CT signs occurred in 68 (29%) patients, corresponding to 97% specificity and 67% sensitivity. A weighted score based on these five CT signs had an 0.88 area under the curve to detect AHF. CONCLUSIONS: Five CT signs seem sufficient to assess the risk of AHF in the acute setting. The absence of these signs indicates a low probability, one sign makes AHF highly probable, and two or more CT signs mean almost certain AHF.
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A 2022 study conducted an observational in Acute dyspnea / Acute heart failure (n=232). Chest computed tomography (CT) signs of heart failure vs. Absence of CT signs was evaluated on Association of enlarged heart on chest CT with acute heart failure (OR 20.38, 95% CI 6.86-76.16). Five chest computed tomography signs, most notably an enlarged heart (OR 20.38), were independently associated with acute heart failure in patients presenting to the emergency department with acute dyspnea.
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