PURPOSE: Pleural effusions frequently accumulate in patients with left heart failure. However, our recent study in idiopathic and heritable pulmonary arterial hypertension (PAH) patients demonstrated that pleural effusions frequently occur in patients with isolated right heart failure (RHF). This study is to determine the incidence of pleural effusions in patients with PAH associated with connective tissue disease (CTD).
METHODS: We retrospectively studied consecutive patients with PAH associated with CTD who were treated in the Vanderbilt Pulmonary Vascular Center. Pleural effusions were identified by chest radiograph, chest computed tomography scan, thoracic ultrasound, or autopsy.
RESULTS: Thirty-five of 89 patients (39.3%) with PAH associated with CTD had pleural effusions: 23/51 (45.1%) with scleroderma, 6/16 (37.5%) with systemic lupus erythematosus (SLE), 5/18 (27.8%) with mixed connective tissue disease (MCTD), and 1/2 (50.0%) with Sjogren's syndrome. There were alternative explanations for the pleural effusions in six of these patients. Of the 29 patients without alternative explanation for their pleural effusions, 28 (96.6%) had RHF. When compared to the patients without pleural effusions, the 29 patients with pleural effusions had significantly higher mean right atrial pressures (11.3 ± 5.1 mmHg vs 8.3 ± 4.0 mmHg, p = 0.004) and lower cardiac indices (2.1 ± 0.6 L.min-1.m-2 vs 2.5 ± 0.7 L.min-1.m-2, p = 0.011). The pleural effusions were predominantly trace to small (58.6%) in size and bilateral (51.7%) in distribution.
CONCLUSION: Pleural effusions frequently accumulate in patients with PAH associated with CTD, and are associated with RHF.
CLINICAL IMPLICATIONS: Pleural effusion is a common complication in not only left heart failure but also right heart failure patients.
DISCLOSURE: Anupama Brixey, No Financial Disclosure Information; No Product/Research Disclosure Information