Utility of thoracic sonography for follow-up examination of chronic heart failure patients with previous decompensation.
BACKGROUND
Thoracic sonography searching for pleural effusion is helpful in diagnosing heart failure (HF) in emergency situations, but utility of this test for follow-up examination of chronic HF patient is unknown.


OBJECTIVE
Thoracic sonography searching for pleural effusion may be suitable for monitoring deterioration in chronic HF outpatients during long-term follow-up.


METHODS
Patients with stable HF at the time of study entry, but with previous deterioration (n = 46) were recruited and followed between June 2003 and September 2005. Evaluated HF-related variables included symptoms and signs of HF, pleural effusion on an ultrasonogram, and B-type natriuretic peptide (BNP) levels.


RESULTS
During the study period, 26 patients developed deterioration in chronic HF and 20 maintained a stable clinical course. Of the 26 patients with deteriorating HF, 25 (96%) demonstrated objective HF-related sign(s) under examination. Among the signs tested in the present study, pleural effusion on a sonogram was the leading HF-related sign (77%), followed by rales (46%) and edema (46%). Eleven patients (42%) presented with only one feature, in which pleural effusion on a sonogram was the most frequent (7 of 11 patients). Using plasma BNP levels as a reference for HF deterioration, sonographic detection of pleural effusion exhibited the highest sensitivity (74%), best negative predictive value (73%), and highest predictive accuracy (78%) for identifying patients with higher BNP levels at deterioration compared to stable periods.


CONCLUSIONS
Thoracic sonography allows sensitive detection of HF deterioration and improves clinical decision making in outpatient clinic during follow-up examination of HF patient with previous decompensation.
Department of Internal Medicine, Nishida Hospital, Oita, Japan. hkata@cream.plala.or.jp
Hajime
H
Kataoka
D000368:Aged; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010996:Pleural Effusion / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain