Abstract
BackgroundPatients 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).MethodsThe 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: ISRCTN96643197ResultsOf 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).ConclusionsRadiographic evidence of congestion on a CXR is very common in patients with AHF and is associated with other clinical measures of worse prognosis.Graphic abstractSigns 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
Highlights
Heart failure (HF) is the leading cause of hospital admission in people aged 65 years or older in developed countries [1]
As hydrostatic pressure increases in the lungs, signs of pulmonary congestion start to appear—pulmonary venous congestion, interstitial oedema, alveolar oedema and pleural effusions—that are often used as entry criteria in trials of therapies for patients presenting with acute HF [5, 6]
Increasing pulmonary congestion on the chest X-ray (CXR) score is related to worsening HF as assessed by other clinical measures such as age, potassium, urea, NT-proBNP, haemoglobin and albumin, and is associated with increasing all-cause mortality, but not related to overall prognosis when these other variables are taken into account
Summary
Heart failure (HF) is the leading cause of hospital admission in people aged 65 years or older in developed countries [1]. There is little relation between cardiothoracic ratio (CTR) and left ventricular systolic function [7]. Patients admitted to hospital with heart failure will have had a chest X-ray (CXR), but little is known about their prognostic significance. 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. 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. 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%). 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
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