Prognostic value of chest radiographs in patients with acute heart failure: the Radiology in Acute Heart Failure (RAD-ICA) study
Llorens P, Javaloyes P, Masip J, Gil V, Herrero-Puente P, Martín-Sánchez FJ, Jacob J, Garrido JM, Herrera-Mateo S, López Díez MP, Concepción Aramendia L, Miró O
Affiliation of the authors
Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, ISABIAL-Fundación FISABIO, Alicante, Spain. Facultad de Medicina, Universitat Miguel Hernández, Elx, Alicante, Spain. Servicio de Cardiología, Hospital CIMA Sanitas, Barcelona, Spain. Servicio de Medicina Intensiva, Consorci Sanitari Integral, Barcelona, Spain. Grupo de Investigación Urgencias: Procesos y Patologías, Área de Urgencias, Hospital Clínic, IDIBAPS, Barcelona, Spain. Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain. Servicio de Urgencias, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Servicio de Urgencias, Hospital Virgen de la Macarena, Sevilla, Spain. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain. Servicio de Radiodiagnóstico, Hospital General de Alicante, Alicante, Spain. Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain.
Llorens P, Javaloyes P, Masip J, Gil V, Herrero-Puente P, Martín-Sánchez FJ, et al. Prognostic value of chest radiographs in patients with acute heart failure: the Radiology in Acute Heart Failure (RAD-ICA) study. Emergencias. 2019;31:318-26
To determine whether chest radiographs can contribute to prognosis in patients with acute heart failure (AHF).
Methods.
Consecutive patients with AHF were enrolled by the participating emergency departments. Radiographic variables assessed were the presence or absence of evidence of cardiomegaly and pleural effusion and the pulmonary parenchymal pattern observed (vascular redistribution, interstitial edema, and/or alveolar edema). We gathered
variables for the AHF episode and the patient’s baseline state. Outcomes were in-hospital and 1-year mortality; hospital stay longer than 7 days, and a composite of events within 30 days of discharge (revisit, rehospitalization, and/or death). Crude and adjusted hazard ratios were calculated for the 3 categories of radiographic variables. The variables were also studied in combination.
Results.
A total of 2703 patients with a mean (SD) age of 81 (19) years were enrolled; 54.5% were women. Cardiomegaly was observed in 1711 cases (76.8%) and pleural effusion in 992 (36.7%). A pulmonary parenchymal pattern was observed in all cases, as follows: vascular redistribution in 1672 (61.9%), interstitial edema in 629
(23.3%) and alveolar edema in 402 (14.9%). The adjusted hazard ratios showed that cardiomegaly lacked prognostic value. However, the presence of pleural effusion was associated with a 23% (95% CI, 2%–49%) higher rate of the 30-day composite outcome; in-hospital mortality was 89% (30%–177%) higher in the presence of alveolar edema, and
1-year mortality was 38% (14%–67%) higher in association with vascular redistribution. The results for the variables in combination were consistent with the results for individual variables.
Conclusions.
A diagnostic chest radiograph can also contribute to the prediction of adverse events. Pleural effusion is associated with a higher rate of events after discharge, and alveolar edema is associated with higher mortality.
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