Prognostic value of the chest X-ray in patients hospitalised for heart failure

Pan, Daniel; Pellicori, Pierpaolo; Dobbs, Karen; Bulemfu, Jeanne; Sokoreli, Ioanna; Urbinati, Alessia; Brown, Oliver; Sze, Shirley; Rigby, Alan S.; Kazmi, Syed; Riistama, Jarno; Cleland, John G.F.; Clark, Andrew L.

doi:10.1007/s00392-021-01836-9

Cited by 13 publications

(6 citation statements)

References 33 publications

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“…Further prospective studies with fewer missing data are needed to validate our findings. Furthermore, there is currently no single established assessment of residual congestion at discharge so that several previous studies were referred 11,22,23 . Thus, evaluation of pulmonary oedema and pleural fluid using lung ultrasound or body weight was not part of this study.…”

Section: Discussionmentioning

confidence: 99%

“…The presence or absence of residual congestion was determined at the time of discharge by several senior cardiologists, and its presence was based on physical examination findings such as orthopnoea, pulmonary rales and peripheral oedema, 11 a reduction in B‐type natriuretic peptide (BNP) of <30% compared with the value at admission, 22 and the presence of pleural effusions detected on chest X‐rays 23 …”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, there is currently no single established assessment of residual conges-tion at discharge so that several previous studies were referred. 11,22,23 Thus, evaluation of pulmonary oedema and pleural fluid using lung ultrasound or body weight was not part of this study. Finally, there is a relatively large proportion of patients being treated with tolvaptan (23.7%) in this study, which is not in line with international guidelines.…”

Section: Study Limitationsmentioning

confidence: 99%

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Association of congestion with worsening renal function in acute decompensated heart failure according to age

et al. 2022

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Aims Acute decompensated heart failure (ADHF) is a frequent cause of hospitalization for patients with heart disease, and ADHF patients are at high risk of heart failure (HF) re‐hospitalization. Residual congestion at discharge is also a strong predictor of poor outcomes and re‐hospitalization for ADHF patients. However, the impact of residual congestion at discharge on worsening renal function (WRF) in both high‐aged and older patients remains uncertain because previous studies of WRF in ADHF patients were conducted for older patients. We therefore designed and conducted a retrospective, population‐based study using the Kobe University Heart Failure Registry in Awaji Medical Center (KUNIUMI) Registry to investigate the association of residual congestion at discharge with WRF in ADHF patients according to age. Methods and results We studied 966 hospitalized ADHF patients with a mean age of 80.2 ± 11.4 years from among 1971 listed in the KUNIUMI Registry. WRF was defined as an increase of ≥0.3 mg/dL in the serum creatinine level during the hospital stay compared with the value on admission. The primary endpoint was defined as cardiovascular death or HF re‐hospitalization after discharge over a mean follow‐up period of 2.0 ± 0.1 years. The primary endpoint was recorded for 369 patients (38.2%). As expected, patients with both WRF and residual congestion at discharge had significantly less favourable outcomes compared with those without one of them, and patients without either of these two characteristics had the most favourable outcomes, whereas those with residual congestion and with WRF had the least favourable outcomes. Moreover, WRF was significantly associated with worse outcomes for high‐aged patients ≥80 years old, but not for those <80 years old if decongested. Multivariable Cox regression analysis showed that both residual congestion at discharge and WRF were the independent predictors of outcomes for high‐aged patients, but residual congestion at discharge, not WRF, was the independent predictor of outcomes for older patients. Conclusions Association of residual congestion at discharge with WRF for hospitalized ADHF patients can differ according to age. Our findings showed the importance of WRF and residual congestion at discharge for high‐aged ADHF patients and of aggressive diuresis to alleviate congestion for older ADHF patients for better management of such patients in a rapidly ageing society.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

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Association of congestion with worsening renal function in acute decompensated heart failure according to age

et al. 2022

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“…The chest radiograph generally reveals enlargement of the heart (except in most cases of hyperkinetic states and diastolic insufficiency), signs of venous congestion in the pulmonary circulation [ 68 ].…”

Section: Diagnosis Of Heart Failure In Patients After Covid-19mentioning

confidence: 99%

The Role of Multidisciplinary Approaches in the Treatment of Patients with Heart Failure and Coagulopathy of COVID-19

Gryglewska-Wawrzak

Cienkowski

Cienkowska

et al. 2023

JCDD

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Coronavirus disease 2019 (COVID-19) is a severe respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Heart failure (HF) is associated with a worse prognosis for patients with this viral infection, highlighting the importance of early detection and effective treatment strategies. HF can also be a consequence of COVID-19-related myocardial damage. To optimise the treatment of these patients, one needs to understand the interactions between this disease and viruses. Until now, the validity of the screening for cardiovascular complications after COVID-19 has not been confirmed. There were also no patients in whom such diagnostics seemed appropriate. Until appropriate recommendations are made, diagnosis procedures must be individualised based on the course of the acute phase and clinical symptoms reported or submitted after COVID-19. Clinical phenomena are the criteria for determining the recommended test panel. We present a structured approach to COVID-19 patients with heart involvement.

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“…For example, in one observational study of 975 HF patients admitted to the hospital, 67% had pleural effusions on erect radiographs. 66 The use of ultrasonography, a more sensitive technique than chest radiographs, also increases the detection of pleural effusions in this setting. Thus, thoracic ultrasound detected pleural effusions in 66% of 188 HF patients soon after hospital admission.…”

Section: Management Of Cardiac Effusionsmentioning

confidence: 99%

Nonmalignant Pleural Effusions

Porcel

2022

Semin Respir Crit Care Med

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Although the potential causes of nonmalignant pleural effusions are many, the management of a few, including complicated pleural infections and refractory heart failure and hepatic hydrothoraces, can be challenging and requires the assistance of interventional pulmonologists. A pragmatic approach to complicated parapneumonic effusions or empyemas is the insertion of a small-bore chest tube (e.g., 14–16 Fr) through which fibrinolytics (e.g., urokinase and alteplase) and DNase are administered in combination. Therapeutic thoracenteses are usually reserved for small to moderate effusions that are expected to be completely aspirated at a single time, whereas video-assisted thoracic surgery should be considered after failure of intrapleural enzyme therapy. Refractory cardiac and liver-induced pleural effusions portend a poor prognosis. In cases of heart failure–related effusions, therapeutic thoracentesis is the first-line palliative therapy. However, if it is frequently needed, an indwelling pleural catheter (IPC) is recommended. In patients with hepatic hydrothorax, repeated therapeutic thoracenteses are commonly performed while a multidisciplinary decision on the most appropriate definitive management is taken. The percutaneous creation of a portosystemic shunt may be used as a bridge to liver transplantation or as a potential definitive therapy in nontransplant candidates. In general, an IPC should be avoided because of the high risk of complications, particularly infections, that may jeopardize candidacy for liver transplantation. Even so, in noncandidates for liver transplant or surgical correction of diaphragmatic defects, IPC is a therapeutic option as valid as serial thoracenteses.

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Prognostic value of the chest X-ray in patients hospitalised for heart failure

Cited by 13 publications

References 33 publications

Association of congestion with worsening renal function in acute decompensated heart failure according to age

Association of congestion with worsening renal function in acute decompensated heart failure according to age

The Role of Multidisciplinary Approaches in the Treatment of Patients with Heart Failure and Coagulopathy of COVID-19

Nonmalignant Pleural Effusions

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