Vol 27, No 3 (2020)
Original articles — Clinical cardiology
Published online: 2018-11-06

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Significance of congestive heart failure as a cause of pleural effusion: Pilot data from a large multidisciplinary teaching hospital

Piotr Korczyński1, Katarzyna Górska1, Damian Konopka2, Dżamila Al-Haj2, Krzysztof J. Filipiak3, Rafał Krenke1
Pubmed: 30406935
Cardiol J 2020;27(3):254-261.


Background: Epidemiological data on the causes of pleural effusion (PE) are scarce. Data on the local prevalence of various causes of PE may play a crucial role in the management strategy of patients with PE. The aim of the study was to investigate the causes of PE and to assess 30-day mortality rate in unselected adult patients treated in a large, multidisciplinary hospital.

Methods: Retrospective analysis of medical records, including chest radiographs, of 2835 consecutive patients admitted to the hospital was performed. Radiograhic signs of PE were found in 195 of 1936 patients in whom chest radigraphs were available. These patients formed the study group.

Results: The leading causes of PE were as follows: congestive heart failure (CHF; 37.4%), pneumonia (19.5%), malignancy (15.4%), liver cirrhosis (4.2%) and pulmonary embolism. The cause of PE in 6.7% patients was not established. There was a significant predominance of small volume PE as compared to a moderate or large volume PEs (153, 28 and 14 patients, respectively). Almost 80% of patients with CHF presented with small volume PE, while almost 50% of patients with malignant PE demonstrated moderate or large volume PE. Thirty-day mortality rate ranged from 0% for tuberculous pleurisy to 40% for malignant PE (MPE).

Conclusions: Pleural effusion was found in 10.1% of patients treated in a large multidisciplinary hospital. CHF was the leading cause of PE. Although 30-day mortality in patients with CHF was rela­tively high, it was lower than that in parapneumonic PE and MPE.

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  1. Light RW. Pleural effusions. Med Clin North Am. 2011; 95(6): 1055–1070.
  2. Porcel JM, Esquerda A, Vives M, et al. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol. 2014; 50(5): 161–165.
  3. Baumann MH, Nolan R, Petrini M, et al. Pleural tuberculosis in the United States: incidence and drug resistance. Chest. 2007; 131(4): 1125–1132.
  4. Porcel JM. Advances in the diagnosis of tuberculous pleuritis. Ann Transl Med. 2016; 4(15): 282.
  5. Mortazavi-Moghaddam SG, Sharifzadeh GR, Rezvani MR. Status of Exudative Pleural Effusion in Adults of South Khorasan Province, Northeast Iran: Pleural Tuberculosis Tending toward Elderly. Iran J Med Sci. 2016; 41(4): 322–327.
  6. Rafiee S, Besharat S, Jabbari A, et al. Epidemiology of tuberculosis in Northeast of Iran: a population-based study. Iran J Med Sci. 2015; 34(3): 193–197.
  7. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on November 2017 submission data (1999-2015): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute;. www.cdc.gov/cancer/dataviz (Accessed June 2018).
  8. Murphy SL, Xu J, Kochanek KD, et al. Deaths: Final Data for 2015. Natl Vital Stat Rep. 2017; 66(6): 1–75.
  9. Cierniak-Piotrowska M, Marciniak G, Stanczuk J. Statystyka Zgonow i Umieralnosci Z Powodu Chorob Układu Krazenia. In: Strzelecki Z, Szymborski J, editors. Zachorowalnosc i umieralnosc na choroby ukladu krazenia a sytuacja demograficzna Polski: Rzadowa Rada Ludnosci. 2015.
  10. Korzeniowska-Kosela M. Gruzlica w Polsce w 2016 roku. Biuletyn IGiChP. 2016.
  11. Didkowska J, Wojciechowska U. Zachorowania i zgony na nowotwory zlosliwe w Polsce. Krajowy Rejestr Nowotworow, Centrum Onkologii - Instytut im. Marii Sklodowskiej - Curie. http://onkologia.org.pl/k/epidemiologia (Accesed June 2018).
  12. Krenke R, Nasilowski J, Korczynski P, et al. Incidence and aetiology of eosinophilic pleural effusion. Eur Respir J. 2009; 34(5): 1111–1117.
  13. Klimiuk J, Krenke R, Safianowska A, et al. Diagnostic performance of different pleural fluid biomarkers in tuberculous pleurisy. Adv Exp Med Biol. 2015; 852: 21–30.
  14. Marel M, Zrůstová M, Stasný B, et al. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest. 1993; 104(5): 1486–1489.
  15. Hooper C, Lee YC, Maskell N. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010; 65 Suppl 2: ii4–i17.
  16. Porcel JM. Pearls and myths in pleural fluid analysis. Respirology. 2011; 16(1): 44–52.
  17. Bielsa S, Porcel JM, Castellote J, et al. Solving the Light's criteria misclassification rate of cardiac and hepatic transudates. Respirology. 2012; 17(4): 721–726.
  18. Han ZJ, Wu XD, Cheng JJ, et al. Diagnostic Accuracy of Natriuretic Peptides for Heart Failure in Patients with Pleural Effusion: A Systematic Review and Updated Meta-Analysis. PLoS One. 2015; 10(8): e0134376.
  19. Porcel J. Identifying transudates misclassified by Lightʼs criteria. Current Opinion in Pulmonary Medicine. 2013; 19(4): 362–367.
  20. Ferreiro L, Gude F, Toubes ME, et al. Predictive models of malignant transudative pleural effusions. J Thorac Dis. 2017; 9(1): 106–116.
  21. Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016; 18(8): 891–975.
  22. Tang KJ, Robbins IM, Light RW. Incidence of pleural effusions in idiopathic and familial pulmonary arterial hypertension patients. Chest. 2009; 136(3): 688–693.
  23. Knudsen CW, Omland T, Clopton P, et al. Diagnostic value of B-Type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. Am J Med. 2004; 116(6): 363–368.
  24. Kataoka H. Pericardial and pleural effusions in decompensated chronic heart failure. Am Heart J. 2000; 139(5): 918–923.
  25. Kataoka H, Takada S. The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. J Am Coll Cardiol. 2000; 35(6): 1638–1646.
  26. Edwards JE, Race GA, Scheifley CH. Hydrothorax in congestive heart failure. Am J Med. 1957; 22(1): 83–89.
  27. Porcel JM, Vives M. Distribution of pleural effusion in congestive heart failure. South Med J. 2006; 99(1): 98–99.
  28. Woodring LA, Cancelli AA, Ponterotto JG, et al. A qualitative investigation of adolescents' experiences with parental HIV/AIDS. Am J Orthopsychiatry. 2005; 75(4): 658–675.
  29. Porcel J. Pleural effusions from congestive heart failure. Semin Respir Crit Care Med. 2011; 31(06): 689–697.
  30. de Araujo BS, Reichert R, Eifer DA, et al. Trepopnea may explain right-sided pleural effusion in patients with decompensated heart failure. Am J Emerg Med. 2012; 30(6): 925–931.e2.
  31. Maggioni AP, Dahlström U, Filippatos G, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013; 15(7): 808–817.
  32. Tymińska A, Kapłon-Cieślicka A, Ozierański K, et al. Anemia at Hospital Admission and Its Relation to Outcomes in Patients With Heart Failure (from the Polish Cohort of 2 European Society of Cardiology Heart Failure Registries). Am J Cardiol. 2017; 119(12): 2021–2029.
  33. Kim ES, Park KU, Lee SH, et al. Comparison of viral infection in healthcare-associated pneumonia (HCAP) and community-acquired pneumonia (CAP). PLoS One. 2018; 13(2): e0192893.
  34. Mirra M, Vitulano G, Virtuoso N, et al. Heart Failure in a Dedicated Outpatient Clinic: Results after 58 Month Follow-Up. Can it be Enough? Transl Med UniSa. 2015; 11: 59–62.