SESSION TYPE: Pleural Disease Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Systolic and diastolic heart failure are the most common causes of pleural effusions. We examined clinical, laboratory and radiologic features of congestive heart failure (CHF) patients with pleural effusions by echocardiographic classification of ventricular dysfunction.
METHODS: We retrospectively evaluated 60 patients with pleural effusions and a diagnosis of uncomplicated CHF. One cardiologist blinded to diagnosis classified echocardiograms as: Group 1 (G1) systolic (ejection fraction <50%); Group 2 (G2) diastolic (EF ≥ 50% with abnormal diastolic function) or Group 3 (G3) combined systolic and diastolic (EF <50% with diastolic dysfunction). Five patients with normal echocardiograms were excluded. We recorded pleural fluid chemistry, cell counts, brain naturetic peptide (BNP), and laterality, and effusions were classified as exudative or transudative by the Light criteria. Patients were followed for six months after index hospitalization to assess for readmission.
RESULTS: There were 15 patients with isolated systolic dysfunction (G1), 26 patients with isolated diastolic dysfunction (G2), and 14 patients with combined systolic and diastolic dysfunction (G3). Mean age was similar for all three CHF groups (overall mean 74.7 years, sd 10.5), but more women had isolated diastolic dysfunction (18.5% G1, 70.9% G2, and 11.1% G3; p=0.003). As expected, median BNP was significantly higher for systolic dysfunction (9188 pg/mL G1, 1214 pg/mL G2, 5962.5 pg/mL G3 ; p=0.01). There was no significant difference in pleural fluid chemistry, cell counts, laterality and Light criteria classification between the three study groups (86.7% G1, 80.0% G2, and 85.7% G3 were transudative; p=0.90). Overall, 57.1 percent of patients were readmitted with higher rates of readmission in groups 2 and 3 (33.3% G1, 61.5% G2, 78.6% G3; p=0.05).
CONCLUSIONS: We found no significant differences in the clinical features of pleural effusions by type of ventricular dysfunction in patients with CHF. Patients with isolated diastolic or diastolic in combination with systolic dysfunction experienced higher rates of re-admission than isolated systolic dysfunction alone.
CLINICAL IMPLICATIONS: Patients with diastolic dysfunction may need closer outpatient follow-up.
DISCLOSURE: The following authors have nothing to disclose: Ghada Mesleh, Fuad Zied, Todd Gress, Shadi Obeidat, Nancy Munn, Paulette Wehner, Abdulrahman Hamo
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