Ultrasound Pleural Effusion Sign as a Useful Marker for Identifying Heart Failure Worsening in Established Heart Failure Patients During Follow‐Up

Abstract

Clinical significance of UltraSound Pleural Effusion (US-PLE) and test characteristics of this sign for identifying worsening heart failure (HF) during follow-up of HF patients are unclear. Clinical records of 83 established HF patients were examined. The diagnosis of worsening HF was classified as "highly certain,""probable,""uncertain," or "no" based on the combination of the changes in symptoms/signs and B-type natriuretic peptide (BNP). Routine test included searching for the US-PLE sign. During a follow-up of 652±456 days, 1826 visits were evaluated. Among the 83 study patients, 78 had at least one of the following: worsening symptom(s), HF-related sign(s), and/or elevated BNP levels (≥3-fold increase) at one or more clinic visits. The US-PLE sign was present at 83 visits of 49 study patients. Its appearance was associated with the presence of HF-related symptom(s)/sign(s) and BNP elevation (odds ratio, 53-177, P<.0001 each). The test characteristics of the US-PLE sign for diagnosis of high possibility of worsening HF status fulfilling the "highly certain" or "probable" criteria were: sensitivity (76.6%), specificity (98.6%), positive predictive value (71.1%), and negative predictive value (99.0%). The US-PLE sign has high diagnostic accuracy for identifying worsening HF, including asymptomatic events, in HF patients during follow-up.

Clinical Utility of Ultrasonographic Detection of Pleural Effusion for Evaluation of Heart Failure Patients

“…The results also demonstrated that the ultrasound signs of pleural effusion had high diagnostic value for identifying heart failure status worsening, confirming that this sign was a useful marker in such patients during follow-up (Kataoka, 2010). Importantly, ultrasound-detected pleural effusion signs were often present in asymptomatic heart failure worsening with the minimal appearance of other heart failure-related signs, which was supported by recent observation (Kataoka, 2011).…”

“…Recent studies have reported that ultrasound signs of pleural effusion were a common presenting heart failure-related sign for established heart failure patients during follow-up (Kataoka, 2007;Kataoka, 2011), and were strongly associated with the appearance of other heart failure-related symptoms and signs (Kataoka, 2010). The results also demonstrated that the ultrasound signs of pleural effusion had high diagnostic value for identifying heart failure status worsening, confirming that this sign was a useful marker in such patients during follow-up (Kataoka, 2010).…”

“…In uncontrolled heart failure, fluid accumulates throughout the body, including in the thorax. The accumulation and retention of body fluid in the pleural (Kataoka & Takada, 2000;Kataoka, 2007Kataoka, , 2010 and/or pericardial (Kataoka, 2000;Movahed et al, 2006) cavities could be suitable targets for clinical evaluation by chest ultrasound in heart failure patients. This review article describes the application of this technique for the evaluation of pleural effusion in heart failure patients.…”

Thoracic ultrasound: A complementary diagnostic tool in cardiology

“…Thereafter, in late 80’s in France[5], the TUS procedure was optimally developed by pneumologists, as it was in Germany[6-8], and in Italy[3] defining appropriately the criteria of pneumothorax and of lung consolidation. The clinical research and practice of TUS in cardiology in late 90’s in Japan, demonstrated the usefulness of detecting and monitoring pleura effusions[25-28,30], an achievement that others subsequently confirmed[29] enhancing the dissemination of knowledge and interest for TUS in Cardiology. The use in pediatric and newborn intensive care facilities was[2,4] and still is[17,38,39] greatly developed with the contribution of pediatric radiologists.…”

Effects of heart failure status on electrocardiogram precordial leads and their value for monitoring body fluid changes in heart failure patients

“…Additional regular evaluation included whether or not the presence of significant fluid weight gain [9], ultrasonographic pleural effusion [12,13], and 3-fold increase in BNP compared to clinical stability [14]. Worsening HF event was diagnosed if two or more combinations of signs/tests appeared.…”