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Lung ultrasound-guided therapeutic thoracentesis in refractory congestive heart failure.

Authors
  • Lazarevic, Aleksandar1, 2
  • Dobric, Milan3, 4
  • Goronja, Boris1
  • Trninic, Dijana1
  • Krivokuca, Svetozar1
  • Jovanic, Jelena1
  • Picano, Eugenio5
  • 1 Division of Cardiovascular Diseases, Faculty of Medicine, University Clinical Center of the Republic of Srpska, University of Banja Luka, Banja Luka, Bosnia and Herzegovina. , (Bosnia & Herzegovina)
  • 2 Cardio Internal Medicine Outpatient Clinic, Banja Luka, Bosnia and Herzegovina. , (Bosnia & Herzegovina)
  • 3 Clinical Center of Serbia, Belgrade, Serbia. , (Serbia)
  • 4 Faculty of Medicine, University of Belgrade, Belgrade, Serbia. , (Serbia)
  • 5 CNR Institute of Clinical Physiology of Pisa, Pisa, Italy. , (Italy)
Type
Published Article
Journal
Acta cardiologica
Publication Date
Sep 01, 2020
Volume
75
Issue
5
Pages
398–405
Identifiers
DOI: 10.1080/00015385.2019.1591677
PMID: 30955462
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Background: Pleural effusion refractory to diuretic treatment is frequent in advanced heart failure. Therapeutic thoracentesis is a time-honored practice, recently made simpler and safer by guidance with lung ultrasound. To assess the feasibility and clinical impact of lung ultrasound-driven therapeutic thoracentesis in refractory heart failure.Methods and results: In a single-centre retrospective analysis we recruited 373 patients with heart failure with reduced ejection fraction (26 ± 12%), New York Heart Association class ≥3, and pleural effusion ≥ moderate at lung ultrasound. All patients underwent lung ultrasound-guided therapeutic thoracentesis. Total of 462 lung ultrasound-guided therapeutic thoracentesis procedures were successfully performed without complications. Evacuated pleural fluid by passive drainage was 1030 ± 534 mL. The maximal interpleural space was 73.6 ± 15.6 mm before, and 12.4 ± 3.1 mm after therapeutic thoracentesis (p < .001). Therapeutic thoracentesis induced an immediate symptomatic improvement in all patients, with New York Heart Association class decrease from 3.84 ± 0.37 pre- to 2.7 ± 0.55 post-therapeutic thoracentesis (p <.001). The improvement was long-lasting (for weeks/months) in 89% of patients. The 6-min walking test was 52 ± 29 m before, and 287 ± 56 m one month after therapeutic thoracentesis (p < .05).Conclusion: Lung ultrasound-driven therapeutic thoracentesis of pleural effusion in decompensated heart failure patients is feasible, safe, and efficient. Therapeutic thoracentesis induces immediate and substantial symptomatic relief followed by long-lasting improvement.

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