Prognostic value of the chest X-ray in patients hospitalised for heart failure.

Abstract

BACKGROUND:

Patients admitted to hospital with heart failure will have had a chest X-ray (CXR), but little is known about their prognostic significance. We aimed to report the prevalence and prognostic value of the initial chest radiograph findings in patients admitted to hospital with heart failure (acute heart failure, AHF).

METHODS:

The erect CXRs of all patients admitted with AHF between October 2012 and November 2016 were reviewed for pulmonary venous congestion, Kerley B lines, pleural effusions and alveolar oedema. Film projection (whether anterior-posterior [AP] or posterior-anterior [PA]) and cardiothoracic ratio (CTR) were also recorded.

TRIAL REGISTRATION:

ISRCTN96643197 RESULTS: Of 1145 patients enrolled, 975 [median (interquartile range) age 77 (68-83) years, 61% with moderate, or worse, left ventricular systolic dysfunction, and median NT-proBNP 5047 (2337-10,945) ng/l] had an adequate initial radiograph, of which 691 (71%) were AP. The median CTR was 0.57 (IQR 0.53-0.61) in PA films and 0.60 (0.55-0.64) in AP films. Pulmonary venous congestion was present in 756 (78%) of films, Kerley B lines in 688 (71%), pleural effusions in 649 (67%) and alveolar oedema in 622 (64%). A CXR score was constructed using the above features. Increasing score was associated with increasing age, urea, NT-proBNP, and decreasing systolic blood pressure, haemoglobin and albumin; and with all-cause mortality on multivariable analysis (hazard ratio 1.10, 95% confidence intervals 1.07-1.13, p < 0.001).

CONCLUSIONS:

Radiographic evidence of congestion on a CXR is very common in patients with AHF and is associated with other clinical measures of worse prognosis. Signs of heart failure are highly prevalent in patients presenting to hospital with acute heart failure and when combined into a chest x-ray score, relate to a worse long term risk of death.

• Authors: Daniel Pan, Pierpaolo Pellicori, Karen Dobbs, Jeanne Bulemfu, Ioanna Sokoreli, Alessia Urbinati, Oliver Brown, Shirley Sze, Alan S Rigby, Syed Kazmi, Jarno M Riistama, John G F Cleland, Andrew L Clark
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 110 Issue 11 Pg. 1743-1756 (Nov 2021) ISSN: 1861-0692 [Electronic] Germany
• PMID: 33754159 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © 2021. The Author(s).

Topics

• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Heart Failure (complications, diagnosis)
• Hospitalization (statistics & numerical data)
• Humans
• Inpatients
• Male
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Pulmonary Edema (diagnosis, etiology)
• Radiography, Thoracic (methods)