Key result
Higher pleural effusion scores at discharge fail to predict 90-day HF readmission or death.
Why the study?
Pleural effusions are common in acute heart failure, but the relevance of pleural effusion size assessed on thoracic ultrasound had not been investigated systematically.
Does the size of pleural effusions on thoracic ultrasound at discharge predict 90-day heart failure rehospitalizations or death in patients with acute heart failure?
Observational (n=188)
Blinded to clinical findings
Does the size of pleural effusions on thoracic ultrasound at discharge predict 90-day heart failure rehospitalizations or death in patients with acute heart failure?
Hazard Ratio: 1.05 (95% CI 0.92–1.19)
p-value: p=0.46
Pleural effusion size on thoracic ultrasound at discharge does not appear to predict 90-day heart failure rehospitalization or death, unlike the number of B-lines on lung ultrasound.
Persistent pleural effusion score at discharge was not associated with 90-day events; leaves open its prognostic value in larger studies.
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.
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Lindner et al. (2020) conducted an observational in Acute heart failure (n=188). Higher pleural effusion score on thoracic ultrasound at discharge vs. Lower pleural effusion score was evaluated on 90-day heart failure rehospitalizations or death (HR 1.05, 95% CI 0.92-1.19, p=0.46). Higher pleural effusion scores on thoracic ultrasound at discharge did not identify patients at increased risk of 90-day heart failure rehospitalization or death (HR 1.05; 95% CI 0.92-1.19; P=0.46).
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