Department of Ultrasound, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine (Shenzhen Traditional Chinese Medicine Hospital), No. 1, Fuhua Road, Futian District, Shenzhen, 518033, China.
Department of Ultrasound, The First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China.
BMC Cardiovasc Disord. 2022 Apr 26;22(1):198. doi: 10.1186/s12872-022-02638-1.
Pleural effusions are common in patients with congestive heart failure. However, there is a need to assess systematically the correlation between effusion volume, extravascular lung water and echocardiographic parameters. We used combined cardiopulmonary ultrasound to evaluate the relationship between effusion volume, extravascular lung water, and echocardiographic parameters in patients with congestive heart failure.
Patients who were hospitalized for congestive heart failure underwent combined cardiopulmonary ultrasound. A semiquantitative score of pleural effusions was derived by pulmonary ultrasound and extravascular lung water was estimated by ultrasound lung comets. The measurements were compared with echocardiographic and clinical results.
Among 168 patients (median age 66 years, 69.6% men), 102 (60.7%) had pleural effusions, 84.3% bilateral, 10.8% right-sided, and 4.9% left-sided. High pleural effusion scores were associated with high ultrasound lung comet scores (P < 0.0001). Compared with patients without pleural effusions, patients with pleural effusions were significantly older and had higher systolic pulmonary artery pressure (SPAP), NT-proBNP, New York Heart Association scale, larger left atrium, larger right ventricle, more severe mitral regurgitation, and worse left and right heart function. Adjusted for age, multiple logistic regression analysis showed that SPAP (OR 5.688, P = 0.006) and E/A (OR 3.941, P = 0.043) were the significant variables and risk factors associated with pleural effusions in heart failure.
For patients with left heart failure, the degree of pleural effusions was associated with pulmonary congestion. Elevated SPAP and E/A were the main risk factors for the formation of pleural effusions in patients with congestive heart failure.
胸腔积液在充血性心力衰竭患者中很常见。然而，需要系统评估胸腔积液量、肺外水和超声心动图参数之间的相关性。我们使用心肺联合超声评估充血性心力衰竭患者胸腔积液量、肺外水与超声心动图参数之间的关系。
因充血性心力衰竭住院的患者接受心肺联合超声检查。通过肺部超声获得胸腔积液的半定量评分，并通过超声肺彗星估计肺外水。将测量结果与超声心动图和临床结果进行比较。
在 168 例患者（中位年龄 66 岁，69.6%为男性）中，102 例（60.7%）有胸腔积液，双侧胸腔积液 84.3%，右侧胸腔积液 10.8%，左侧胸腔积液 4.9%。胸腔积液评分较高与超声肺彗星评分较高相关（P<0.0001）。与无胸腔积液的患者相比，有胸腔积液的患者年龄较大，肺动脉收缩压（SPAP）、N 末端脑钠肽前体（NT-proBNP）、纽约心脏协会（NYHA）分级、左心房较大、右心室较大、二尖瓣反流更严重，左、右心功能更差。调整年龄后，多元逻辑回归分析显示，SPAP（OR 5.688，P=0.006）和 E/A（OR 3.941，P=0.043）是胸腔积液与心力衰竭相关的显著变量和危险因素。
对于左心衰竭患者，胸腔积液程度与肺淤血相关。升高的 SPAP 和 E/A 是充血性心力衰竭患者胸腔积液形成的主要危险因素。
