PURPOSE: The aim of this study was to determine the usefulness of thoracic ultrasonography for detecting deterioration in chronic heart failure (HF) patients during follow-up.
METHODS: A total of 46 stable chronic HF patients at entry were followed up between June 2003 and September 2005. Evaluated HF-related variables included symptoms, signs, pleural effusion on an ultrasonogram and plasma brain natriuretic peptide (BNP) levels.
RESULTS: During the study period, 26 patients developed acute on chronic HF decompensation and 20 maintained a stable clinical course. Twenty-five decompensated HF patients (96%) demonstrated objective HF-related sign(s) under examination. Among the HF-related signs tested in the present study, pleural effusion on an ultrasonogram was the leading HF-related sign (77%), followed by rales (46%) and edema (46%). Eleven patients (42%) presented with only one feature of HF-related signs, in which pleural effusion on an ultrasonogram was the most frequent sign (7 of 11 patients). Based on the plasma BNP levels as reference for HF decompensation, the detection of pleural effusion by ultrasonography exhibited the best sensitivity (74%), best negative predictive value (73%), and the highest predictive accuracy (78%) for identifying patients with higher BNP levels at decompensation than during stable periods.
CONCLUSION: With a high sensitivity, pleural effusion on an ultrasonogram is able to detect many chronic HF patients with deterioration, and the excellent negative predictive value of this sign could allow excluding the possibility of decompensated status in chronic HF patients during follow-up.
CLINICAL IMPLICATIONS: The ultrasonographic method is an evolving imaging modality that has found new uses in critically ill patients including HF patients. The present study has firstly shown the diagnostic utility of thoracic ultrasonography for following up of chronic HF patients.
DISCLOSURE: Hajime Kataoka, None.