Utility of Thoracic Sonography for Follow‐up Examination of Chronic Heart Failure Patients with Previous Decompensation

Abstract

SummaryBackground: Thoracic sonography searching for pleural effusion is helpful in diagnosing heart failure (HF) in emergency situations, but utility of this test for follow-up examination of chronic HF patient is unknown.Hypothesis: Thoracic sonography searching for pleural effusion may be suitable for monitoring deterioration in chronic HF outpatients during long-term follow-up.Methods: Patients with stable HF at the time of study entry, but with previous deterioration (n = 46) were recruited and followed between June 2003 and September 2005. Evaluated HF-related variables included symptoms and signs of HF, pleural effusion on an ultrasonogram, and B-type natriuretic peptide (BNP) levels.Results: During the study period, 26 patients developed deterioration in chronic HF and 20 maintained a stable clinical course. Of the 26 patients with deteriorating HF, 25 (96%) demonstrated objective HF-related sign(s) under examination. Among the signs tested in the present study, pleural effusion on a sonogram was the leading HF-related sign (77%), followed by rales (46%) and edema (46%). Eleven patients (42%) presented with only one feature, in which pleural effusion on a sonogram was the most frequent (7 of 11 patients). Using

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

“…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).…”

“…The patient is placed in a sitting position on a bed or chair, and chest ultrasound is performed on each hemithorax using a transducer through the intercostal space, and scanning is performed along the paravertebral, scapular, and posterior axillary lines (Kataoka & Takada, 2000;Kataoka, 2007;Piccoli et al, 2005;Waggoner et al, 1995). Using a high resolution (3.5-5.0 MHz) transducer applied to the chest wall, the parietal pleura lining the bony thorax and the visceral pleura covering the lung are seen just beneath the chest wall as two thin and bright echogenic lines.…”

“…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.…”

Age-Related Pulmonary Crackles (Rales) in Asymptomatic Cardiovascular Patients

“…[22][23][24] Superimposition of changes caused by aging or other diseases, such as frequent leg edema in association with peripheral venous insuffi ciency in the elderly, might obscure the typical signs observed in younger patients. Age-related crackles in elderly patients with cardiovascular disease might be mistakenly diagnosed as a sign of heart failure deterioration, and a danger exists when diuretic therapy is inappropriately instituted.…”

“…Age-related crackles in elderly patients with cardiovascular disease might be mistakenly diagnosed as a sign of heart failure deterioration, and a danger exists when diuretic therapy is inappropriately instituted. 4,14 Elderly patients with chronic heart failure and previous decompensation often have persistent pulmonary crackles, even during stable periods, 22 associated in some cases with the agerelated phenomena, not heart failure status. Whether crackles are related to cardiac dysfunction should be interpreted in light of other clinical tests including, for example, Doppler echocardiography, 7,8 serum BNP measurement, 17,22,25 or thoracic CT scans.…”