title: Frequency of pleural effusions in patients with pulmonary arterial hypertension associated with connective tissue diseases.
abstract: BACKGROUND
  Pleural effusions frequently accumulate in patients with left-sided heart failure. However, our recent study in patients with idiopathic and heritable pulmonary arterial hypertension (PAH) demonstrated that pleural effusions frequently occur in patients with isolated right-sided heart failure (RHF). The objective of this study was to determine the frequency of pleural effusions in patients with PAH associated with connective tissue disease (CTD).
  
  
  METHODS
  We retrospectively studied consecutive patients with PAH associated with CTD who were treated in the Vanderbilt Pulmonary Vascular Center. Pleural effusions were identified by chest radiograph, chest CT scan, thoracic ultrasonography, or autopsy.
  
  
  RESULTS
  Thirty-five of 89 patients (39.3%) with PAH associated with CTD had pleural effusions: 23 of 51 (45.1%) with scleroderma, six of 16 (37.5%) with systemic lupus erythematosus, five of 18 (27.8%) with mixed connective tissue disease, and one of two (50.0%) with Sjögren syndrome. There were alternative explanations for the pleural effusions in six of these patients. Of the 29 patients without alternative explanation for their pleural effusions, 28 had RHF. When compared with the patients without pleural effusions, the 29 patients with pleural effusions had significantly higher mean right atrial pressures (11.3 ± 5.1 mm Hg vs 8.3 ± 4.0 mm Hg, P = .004) and lower cardiac indices (2.1 ± 0.6 L/min/m(2) vs 2.5 ± 0.7 L/min/m(2), P = .011). The pleural effusions were predominantly trace to small (58.6%) in size and bilateral (51.7%) in distribution.
  
  
  CONCLUSIONS
  Pleural effusions frequently accumulate in patients with PAH associated with CTD and are associated with RHF.
authors.affiliation: Department of Pulmonary Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: luoyifeng77@hotmail.com.
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Luo
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Robbins
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Pulmonary Medicine, Ahi Evren Thoracic Heart and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey.
authors.forename: Mevlut
authors.initials: M
authors.lastname: Karatas
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Anupama G
authors.initials: AG
authors.lastname: Brixey
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Light
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D003240:Connective Tissue Diseases / Q000150:complications* / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed