Pleural Effusions in Acute Decompensated Heart Failure: Prevalence and Prognostic Implications

Background: The incidence of pleural effusions (PEs) in acute decompensated heart failure (ADHF) is not well established. We aimed to determine their prevalence, clinical characteristics and prognostic implications. Methods: Retrospective review of 3245 consecutive patients with ADHF from the Spanish RICA Registry. The clinical characteristics of those with or without PEs on chest radiographs were compared and a predictive PE model was generated. Results: Patient's median age was 80 years and 60% had a left ventricular ejection fraction (LVEF) > 50%. PEs were seen in 46% of the cases, and their distribution was as follows: 58% bilateral, 27% right-sided and 14% left-sided. Male gender (OR 2.18; 95%CI 1.23-3.87), serum amino-terminal fraction of the pro-brain natriuretic peptide (NT-pro-BNP) levels > 3500 pg/ml (OR 2.2; 95%CI 1.25-3.77), estimated systolic pulmonary artery pressure (sPAP) > 55 mm Hg by echocardiography (OR 2.05; 95%CI 1.12-3.75), and serum prealbumin < 15 mg/l (OR 1.96; 95%CI 1.08-3.52) were associated with PE development in a multivariate analysis. Serum NT-pro-BNP > 8000 pg/ml, and systolic arterial pressure < 110 mm Hg, but not PEs, independently predicted overall 1-year mortality. Conclusions: PEs are present on chest radiographs in nearly half of ADHF patients. They are mainly bilateral or right-sided and predominate in males with elevated sPAP on echocardiography and high serum levels of NT-pro-BNP. PEs do not independently predict 1-year mortality.