PURPOSE: It is generally accepted that pleural effusions accumulate in with left but not right heart failure. However, our recent two studies in patients with idiopathic and heritable pulmonary arterial hypertension (PAH) and PAH associated with connective tissue diseases demonstrated that pleural effusions frequently occur in patients with isolated right heart failure (RHF). The aim of this study is to determine the incidence of pleural effusions in patients with portopulmonary hypertension (POPH).
METHODS: We retrospectively studied consecutive patients with POPH 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: Twelve of 33 patients (36.4%) with POPH had pleural effusions. Four of these 12 patients had alternative explanations for the pleural effusions. Of the 8 patients without alternative explanation for their pleural effusions, 7 had RHF. When compared to the patients without pleural effusions, the 8 patients with pleural effusions had significantly higher mean right atrial pressures (13.8 ± 6.3 mmHg vs 7.9 ± 6.4 mmHg, p = 0.035), higher serum brain natriuretic peptide (BNP) level (1017.9 ± 536.2 pg/ml vs 303.1 ± 318.9 pg/ml, P<0.001) and shorter walking distance with the six-minute walk test (342.0±84.9 m vs 423.3±72.0 m, P = 0.020). The pleural effusions were predominantly trace to small (62.5%) in size and bilateral (50.0%) in distribution.
CONCLUSION: Pleural effusions are common complications in patients with POPH, and most of them can be attributed to RHF.
CLINICAL IMPLICATIONS: Pleural effusions frequently occur in not only left heart failure but also with right heart failure.
DISCLOSURE: Anupama Brixey, No Financial Disclosure Information; No Product/Research Disclosure Information