Pleural effusion is a common finding in patients with congestive heart failure (CHF). The pathogenesis of pleural effusion in heart failure is multifactorial. However, the role of right and left ventricular function assessed by ECHO cardiogram has not been studied. Therefore, we explored the association between right and left ventricular parameters on echocardiogram in patients with heart failure with and without pleural effusion diagnosed using CT scan of chest.
A case–control study was utilized to explore the objectives. Using strict exclusion criteria, patients admitted with a single diagnosis of acute CHF were stratified into those with and without pleural effusion using CT scan of chest done at admission. Multiple logistic regression analysis was used to identify significant factors associated with pleural effusion.
Among the 70 patients, 36 (51%) had pleural effusions. The mean E/A ratio in patients with effusion (2.53 ± 1.1) was significantly higher than in patients without effusion (1.15 ± 0.9), p < 0.01. Multiple logistic regression analysis showed that elevated E/A ratio was significantly associated with pleural effusion, OR 3.26 (95% CI 1.57–6.77, p < 0.009). Left ventricular ejection fraction (LVEF), septal Eʹ, lateral Eʹ, and medial E/Eʹ ratio were not significantly different in patients with and without pleural effusion.
Elevated E/A ratio is a risk factor for the formation of pleural effusion in patients with heart failure.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Morales-Rull JL, Bielsa S, Conde-Martel A, Aramburu-Bodas O, Llacer P, Quesada MA, Suarez-Pedreira I, Manzano L, Barquero MM, Porcel JM, Group RI (2018) Pleural effusions in acute decompensated heart failure: prevalence and prognostic implications. Eur J Intern Med 52:49–53
Smith MJ, Joseph J, Flatman WD, Basran GS (1992) A dual-isotope method for studying protein kinetics in pleural effusions in humans. Nucl Med Commun 13:432–439
Wiener-Kronish JP, Matthay MA, Callen PW, Filly RA, Gamsu G, Staub NC (1985) Relationship of pleural effusions to pulmonary hemodynamics in patients with congestive heart failure. Am Rev Respir Dis 132:1253–1256
Johns SM, Nelson OL, Gay JM (2012) Left atrial function in cats with left-sided cardiac disease and pleural effusion or pulmonary edema. J Vet Intern Med 26:1134–1139
Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP (2019) Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J Am Coll Cardiol 73:1961–1977
Rosca M, Popescu BA, Beladan CC, Calin A, Muraru D, Popa EC, Lancellotti P, Enache R, Coman IM, Jurcut R, Ghionea M, Ginghina C (2010) Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy. J Am Soc Echocardiogr 23:1090–1098
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD, Houston T, Oslo N, Phoenix A, Nashville T, Hamilton OC, Uppsala S, Ghent, Liege B, Cleveland O, Novara I, Rochester M, Bucharest R, St. Louis M (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17:1321–1360
Bakirci T, Sasak G, Ozturk S, Akcay S, Sezer S, Haberal M (2007) Pleural effusion in long-term hemodialysis patients. Transplant Proc 39:889–891
Eid AA, Keddissi JI, Kinasewitz GT (1999) Hypoalbuminemia as a cause of pleural effusions. Chest 115:1066–1069
Gaar KA Jr, Taylor AE, Owens LJ, Guyton AC (1967) Effect of capillary pressure and plasma protein on development of pulmonary edema. Am J Physiol 213:79–82
Kinasewitz GT, Fishman AP (1981) Influence of alterations in Starling forces on visceral pleural fluid movement. J Appl Physiol Respir Environ Exerc Physiol 51:671–677
Mellins RB, Levine OR, Fishman AP (1970) Effect of systemic and pulmonary venous hypertension on pleural and pericardial fluid accumulation. J Appl Physiol 29:564–569
Wiener-Kronish JP, Matthay MA (1988) Pleural effusions associated with hydrostatic and increased permeability pulmonary edema. Chest 93:852–858
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314
Redfield MM (2016) Heart failure with preserved ejection fraction. N Engl J Med 375:1868–1877
Enriquez-Sarano M, Rossi A, Seward JB, Bailey KR, Tajik AJ (1997) Determinants of pulmonary hypertension in left ventricular dysfunction. J Am Coll Cardiol 29:153–159
We thank Professor Paul Mills Ph.D., MPH with the Division of Epidemiology, UCSF Fresno, for suggestions on study design, protocols, and statistical analysis. We thank Amit Kalra BS for extraction of data from study subjects
Conflict of interest
None of authors have any conflict of interest.
This study was approved by the local IRB.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Rajyaguru, C., Kalra, A., Samim, A. et al. Increased E/A Ratio is a Risk Factor for the Formation of Pleural Effusion in Heart Failure. Lung 198, 229–233 (2020). https://doi.org/10.1007/s00408-019-00308-2
- Pleural effusion
- Systolic dysfunction
- Diastolic dysfunction
- E/A ratio