Prognostic value of chest radiographs in patients with acute heart failure: the Radiology in Acute Heart Failure (RAD-ICA) study
Por:
Llorens, P, Javaloyes, P, Masip, J, Gil, V, Herrero-Puente, P, Martin-Sanchez, FJ, Jacob, J, Garrido, JM, Herrera-Mateo, S, Diez, MPL, Concepcion-Aramendia, L, Miro, O, Fuentes, M, Gil, C, Alonso, H, Perez-Llantada, E, Garcia, GL, Cadenas, MS, Escoda, R, Xipell, C, Sanchez, C, Perez-Dura, MJ, Salvo, E, Pavon, J, Noval, A, Torres, JM, Lopez-Grima, ML, Valero, A, Juan, MA, Aguirre, A, Pedragosa, MA, Maso, SM, Alonso, MI, Ruiz, F, Franco, JM, Mecina, AB, Tost, J, Berenguer, M, Donea, R, Ramon, SS, Rodriguez, VC, Pinera, P, Nicolas, JAS, Garate, RT, Alquezar-Arbe, A, Rizzi, MA, Herrera, S, Roset, A, Cabello, I, Haro, A, Richard, F, Perez, JMA, Puente, PH, Alvarez, JV, Garcia, BP, Garcia, MG, Gonzalez, MS, Marquina, V, Jimenez, I, Hernandez, N, Brouzet, B, Espinosa, B, Gil, A, Andueza, JA, Romero, R, Ruiz, M, Calvache, R, Serralta, MTL, Jave, LEC, Arriaga, BA, Bergua, BS, Mojarro, EM, Jimenez, BSA, Becquer, LT, Burillo, G, Garcia, LL, LaSalle, CC, Urbano, CA, Soto, ABG, Padial, ED, Ferrer, ES, Munoz, MA, Lucas-Imbernon, FJ, Gaya, R, Bibiano, C, Mir, M, Rodriguez, B, Carballo, JL, Rodriguez-Adrada, E, Miranda, BR, Martin, MV
Publicada:
1 oct 2019
Resumen:
Objective. 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 30day 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.
Filiaciones:
Llorens, P:
ISABIAL Fdn FISABIO, Hosp Gen Alicante, Serv Urgencias Corta Estancia & Hosp Domicilio, Alicante, Spain
Univ Miguel Hernandez, Fac Med, Alicante, Spain
Hosp Gen Alicante, Alicante, Spain
Javaloyes, P:
ISABIAL Fdn FISABIO, Hosp Gen Alicante, Serv Urgencias Corta Estancia & Hosp Domicilio, Alicante, Spain
Hosp Gen Alicante, Alicante, Spain
Masip, J:
Hosp CIMA Sanitas, Serv Cardiol, Barcelona, Spain
Consorci Sanitari Integral, Serv Med Intens, Barcelona, Spain
Gil, V:
Hosp Clin Barcelona, IDIBAPS, Area Urgencias, Grp Invest Urgencias Proc & Patol, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Herrero-Puente, P:
Hosp Univ Cent Asturias, Serv Urgencias, Oviedo, Asturias, Spain
Martin-Sanchez, FJ:
Univ Complutense, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Serv Urgencias, Madrid, Spain
Hosp Clin San Carlos, Madrid, Spain
Jacob, J:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Hosp Univ Bellvitge, Barcelona, Spain
Garrido, JM:
Hosp Virgen de la Macarena, Serv Urgencias, Seville, Spain
Hosp Virgen Macarena, Seville, Spain
Herrera-Mateo, S:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Diez, MPL:
Hosp Univ Burgos, Serv Urgencias, Burgos, Spain
Hosp Univ Burgos, Burgos, Spain
Concepcion-Aramendia, L:
Hosp Gen Alicante, Serv Radiodiagnost, Alicante, Spain
Miro, O:
Hosp Clin Barcelona, IDIBAPS, Area Urgencias, Grp Invest Urgencias Proc & Patol, Barcelona, Spain
Univ Barcelona, Fac Med, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Fuentes, M:
Hosp Univ Salamanca, Salamanca, Spain
Hosp Dr Negrin, Las Palmas Gran Canaria, Spain
Gil, C:
Hosp Univ Salamanca, Salamanca, Spain
Hosp Insular, Las Palmas Gran Canaria, Spain
Alonso, H:
Hosp Marques de Valdecilla, Santander, Spain
Hosp Reina Sofia, Cordoba, Spain
Perez-Llantada, E:
Hosp Marques de Valdecilla, Santander, Spain
Garcia, GL:
Hosp Clin San Carlos, Madrid, Spain
Cadenas, MS:
Hosp Clin San Carlos, Madrid, Spain
Escoda, R:
Hosp Clin Barcelona, Barcelona, Spain
Xipell, C:
Hosp Clin Barcelona, Barcelona, Spain
Sanchez, C:
Hosp Clin Barcelona, Barcelona, Spain
Perez-Dura, MJ:
Hosp Politen La Fe, Valencia, Spain
Salvo, E:
Hosp Politen La Fe, Valencia, Spain
Pavon, J:
Hosp Univ Salamanca, Salamanca, Spain
Hosp Dr Negrin, Las Palmas Gran Canaria, Spain
Noval, A:
Hosp Univ Salamanca, Salamanca, Spain
Hosp Insular, Las Palmas Gran Canaria, Spain
Torres, JM:
Hosp Marques de Valdecilla, Santander, Spain
Hosp Reina Sofia, Cordoba, Spain
Lopez-Grima, ML:
Hosp Dr Peset, Valencia, Spain
Valero, A:
Hosp Dr Peset, Valencia, Spain
Juan, MA:
Hosp Dr Peset, Valencia, Spain
Aguirre, A:
Hosp del Mar, Barcelona, Spain
Pedragosa, MA:
Hosp del Mar, Barcelona, Spain
Maso, SM:
Hosp del Mar, Barcelona, Spain
Alonso, MI:
Hosp Valme, Seville, Spain
Ruiz, F:
Hosp Valme, Seville, Spain
Franco, JM:
Hosp Miguel Servet, Zaragoza, Spain
Mecina, AB:
Hosp Alcorcon, Madrid, Spain
Tost, J:
Consorci Sanitari Terrassa, Barcelona, Spain
Berenguer, M:
Consorci Sanitari Terrassa, Barcelona, Spain
Donea, R:
Consorci Sanitari Terrassa, Barcelona, Spain
Ramon, SS:
Hosp Univ Rio Hortega, Valladolid, Spain
Rodriguez, VC:
Hosp Univ Rio Hortega, Valladolid, Spain
Pinera, P:
Hosp Reina Sofia, Murcia, Spain
Nicolas, JAS:
Hosp Reina Sofia, Murcia, Spain
Garate, RT:
Hosp Severo Ochoa, Madrid, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Rizzi, MA:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Herrera, S:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Roset, A:
Hosp Univ Bellvitge, Barcelona, Spain
Cabello, I:
Hosp Univ Bellvitge, Barcelona, Spain
Haro, A:
Hosp Univ Bellvitge, Barcelona, Spain
Richard, F:
Hosp Marques de Valdecilla, Santander, Spain
Hosp Univ Burgos, Burgos, Spain
Perez, JMA:
Hosp Clin San Carlos, Madrid, Spain
Hosp Univ Burgos, Burgos, Spain
Puente, PH:
Hosp Univ Cent Asturias, Oviedo, Spain
Alvarez, JV:
Hosp Univ Cent Asturias, Oviedo, Spain
Garcia, BP:
Hosp Univ Cent Asturias, Oviedo, Spain
Garcia, MG:
Hosp Univ Cent Asturias, Oviedo, Spain
Gonzalez, MS:
Hosp Univ Cent Asturias, Oviedo, Spain
Marquina, V:
Hosp Clin San Carlos, Madrid, Spain
Hosp Gen Alicante, Alicante, Spain
Jimenez, I:
Hosp Clin Barcelona, Barcelona, Spain
Hosp Gen Alicante, Alicante, Spain
Hernandez, N:
Hosp Clin Barcelona, Barcelona, Spain
Hosp Gen Alicante, Alicante, Spain
Brouzet, B:
Hosp Clin Barcelona, Barcelona, Spain
Hosp Gen Alicante, Alicante, Spain
Espinosa, B:
Hosp Politen La Fe, Valencia, Spain
Hosp Gen Alicante, Alicante, Spain
Gil, A:
Hosp Politen La Fe, Valencia, Spain
Hosp Gen Alicante, Alicante, Spain
Andueza, JA:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Romero, R:
Hosp Univ Getafe, Madrid, Spain
Ruiz, M:
Hosp Henares, Madrid, Spain
Calvache, R:
Hosp Henares, Madrid, Spain
Serralta, MTL:
Hosp Tajo, Madrid, Spain
Jave, LEC:
Hosp Tajo, Madrid, Spain
Arriaga, BA:
Hosp Clin Lozano Blesa, Zaragoza, Spain
Bergua, BS:
Hosp Clin Lozano Blesa, Zaragoza, Spain
Mojarro, EM:
Hosp St Pau & Santa Tecla, Tarragona, Spain
Jimenez, BSA:
Hosp St Pau & Santa Tecla, Tarragona, Spain
Becquer, LT:
Hosp Univ Canarias, Tenerife, Spain
Burillo, G:
Hosp Univ Canarias, Tenerife, Spain
Garcia, LL:
Hosp Univ Vic, Barcelona, Spain
LaSalle, CC:
Hosp Univ Vic, Barcelona, Spain
Urbano, CA:
Hosp Costa del Sol, Malaga, Spain
Soto, ABG:
Hosp Costa del Sol, Malaga, Spain
Padial, ED:
Hosp Costa del Sol, Malaga, Spain
Ferrer, ES:
Hosp Josep Trueta, Girona, Spain
Munoz, MA:
Hosp Josep Trueta, Girona, Spain
Lucas-Imbernon, FJ:
Hosp Gen Univ Albacete, Albacete, Spain
Gaya, R:
Hosp Joan 23, Tarragona, Spain
Bibiano, C:
Hosp Infanta Leonor, Madrid, Spain
Mir, M:
Hosp Infanta Leonor, Madrid, Spain
Rodriguez, B:
Hosp Infanta Leonor, Madrid, Spain
Carballo, JL:
Complejo Hosp Univ Ourense, Orense, Spain
Rodriguez-Adrada, E:
Hosp Rey Juan Carlos Mostoles, Madrid, Spain
Miranda, BR:
Hosp Rey Juan Carlos Mostoles, Madrid, Spain
Martin, MV:
Hosp Rey Juan Carlos Mostoles, Madrid, Spain
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