Disorders of the Pleura |

Left Ventricular Diastolic Dysfunction Predicts Presence of Pleural Effusion Better Than Left Ventricular Ejection Fraction in Congestive Heart Failure FREE TO VIEW

Amita Kalra, MD; Arang Samim, MD; Amit Kalra, BS; Jacki Deguzman, MD; Belayneh Abejie, MD; Ralph Wessel, MD; Jose Vempilly, MD
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UCSF Fresno, Fresno, CA

Chest. 2013;144(4_MeetingAbstracts):518A. doi:10.1378/chest.1704510
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SESSION TITLE: Pleural Effusions

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM

PURPOSE: Pleural effusions are commonly seen in patients with congestive heart failure (CHF). However, the pathogenesis of this association is not well understood. Although poor left ventricular ejection fraction (LVEF) has been implicated in the development of pleural effusions, other parameters such as diastolic dysfunction have not been systematically investigated. In this study, we analyzed the association between LVEF, mitral early (E) to late (A) filling (E/A ratio) and presence of pleural effusion.

METHODS: Patients admitted to a teaching hospital with a diagnosis of CHF based on ICD-9 codes who underwent simultaneous CT chest and echocardiography were identified. Patients with known causes of pleural effusion other than CHF were excluded. Similarly, a control group of patients with heart failure without pleural effusion was identified. An academic cardiologist blinded to patient information read the echocardiograms. A radiologist reviewed the CT images for presence of pleural effusion. Age, BMI, and echocardiographic measurements were included in the model as covariates with the outcome variable being presence of pleural effusion. A stepwise logistic regression analysis was used to estimate this association. Nagelkerke R-value assessed the model strength.

RESULTS: Among the 70 patients, 47% (33) were female and 53% (37) were male. The mean age was 57 ± 15. Of the 36 patients with effusion, 5% of them were left sided, 28% were right sided 67% were bilateral. The mean E/A ratio in patients with effusion (2.53±1.1) was significantly higher than in patients without effusion (1.15±0.9), p<0.01. A multiple logistic regression analysis showed that the significant predictor for pleural effusion was an abnormally elevated E/A ratio (p<0.01). LVEF, age and BMI were not significantly associated with the presence of pleural effusion.

CONCLUSIONS: An elevated E/A ratio predicts the presence of pleural effusion among all echocardiographic measurements in a cohort of patients with CHF.

CLINICAL IMPLICATIONS: The development of pleural effusion is more attributable to diastolic dysfunction than systolic dysfunction in CHF. Treatment of such patients should be targeted at improving diastolic dysfunction.

DISCLOSURE: The following authors have nothing to disclose: Amita Kalra, Arang Samim, Amit Kalra, Jacki Deguzman, Belayneh Abejie, Ralph Wessel, Jose Vempilly

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