Is there a potential role for echocardiography in adult patients with CAP?
BACKGROUND
The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP.


METHODS
A total of 111 unselected consecutive adult patients hospitalized with CAP were enrolled. The control group consisted of 100 consecutive sex- and age-matched patients. The severity of CAP was evaluated with the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. Blood samples were taken and echocardiography was performed within the first 48 hours.


RESULTS
White blood count, N-terminal pro-brain natriuretic peptide, and red blood cell distribution width were significantly higher in the CAP group compared with the control group. The 2 groups did not differ in terms of left and right ventricle ejection fraction, left atrial diameter, pulmonary artery systolic pressure, and left ventricular end-diastolic and end-systolic diameter. However, tricuspid annular plane systolic excursion (21.1 ± 4.3 vs 22.3 ± 4.1 mm; P = .04), aortic distensibility (2.5 ± 0.9 vs 3.5 ± 0.9 cm(2):dyne:10, P < .001), and aortic strain (5.8% ± 2% vs 6.5% ± 1.9%, P = .009) were significantly reduced in CAP group than in controls. The plasma concentration of N-terminal pro-brain natriuretic peptide correlated with aortic strain, aortic distensibility, tricuspid annular plane systolic excursion, pneumonia severity index score, and CURB-65 score.


CONCLUSIONS
Tricuspid annular plane systolic excursion and elastic properties of aorta may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of new prognostic models.
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine. Electronic address: birdalgul@gul.com.
Birdal
B
Yıldırım
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology.
Funda Sungur
FS
Biteker
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology.
Özcan
Ö
Başaran
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine.
Ömer Doğan
ÖD
Alataş
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine.
Ethem
E
Acar
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology.
Hamdi
H
Sözen
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology.
Volkan
V
Doğan
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine.
Halil
H
Beydilli
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology.
Selmin Dirgen
SD
Çaylak
D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D017714:Community-Acquired Infections; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011014:Pneumonia / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D019210:Troponin I / Q000097:blood; D016278:Ventricular Function, Right / Q000502:physiology*
D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain