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Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea
BACKGROUND: Pulmonary congestion is a key component of heart failure (HF) that chest computed tomography (CT) can detect. However, no guideline describes which of many anticipated CT signs are most associated with HF in patients with undifferentiated dyspnea. METHODS: In a prospective observational...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Via Medica
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9007481/ https://www.ncbi.nlm.nih.gov/pubmed/35146729 http://dx.doi.org/10.5603/CJ.a2022.0004 |
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author | Miger, Kristina Fabricius-Bjerre, Andreas Olesen, Anne Sophie Overgaard Sajadieh, Ahmad Høst, Nis Køber, Nanna Abild, Annemette Wille, Mathilde Marie Winkler Wamberg, Jesper Pedersen, Lars Schultz, Hans Henrik Lawaetz Torp-Pedersen, Christian Nielsen, Olav Wendelboe |
author_facet | Miger, Kristina Fabricius-Bjerre, Andreas Olesen, Anne Sophie Overgaard Sajadieh, Ahmad Høst, Nis Køber, Nanna Abild, Annemette Wille, Mathilde Marie Winkler Wamberg, Jesper Pedersen, Lars Schultz, Hans Henrik Lawaetz Torp-Pedersen, Christian Nielsen, Olav Wendelboe |
author_sort | Miger, Kristina |
collection | PubMed |
description | BACKGROUND: Pulmonary congestion is a key component of heart failure (HF) that chest computed tomography (CT) can detect. However, no guideline describes which of many anticipated CT signs are most associated with HF in patients with undifferentiated dyspnea. METHODS: In a prospective observational single-center study, we included consecutive patients ≥ 50 years admitted with acute dyspnea to the emergency department. Patients underwent immediate clinical examination, blood sampling, echocardiography, and CT. Two radiologists independently evaluated all images. Acute HF (AHF) was adjudicated by an expert panel blinded to radiology images. LASSO and logistic regression identified the independent CT signs of AHF. RESULTS: Among 232 patients, 102 (44%) had AHF. Of 18 examined CT signs, 5 were associated with AHF (multivariate odds ratio, 95% confidence interval): enlarged heart (20.38, 6.86–76.16), bilateral interlobular thickening (11.67, 1.78–230.99), bilateral pleural effusion (6.39, 1.98–22.85), and increased vascular diameter (4.49, 1.08–33.92). Bilateral ground-glass opacification (2.07, 0.95–4.52) was a consistent fifth essential sign, although it was only significant in univariate analysis. Eighty-eight (38%) patients had none of the five CT signs corresponding to a 68% specificity and 86% sensitivity for AHF, while two or more of the five CT signs occurred in 68 (29%) patients, corresponding to 97% specificity and 67% sensitivity. A weighted score based on these five CT signs had an 0.88 area under the curve to detect AHF. CONCLUSIONS: Five CT signs seem sufficient to assess the risk of AHF in the acute setting. The absence of these signs indicates a low probability, one sign makes AHF highly probable, and two or more CT signs mean almost certain AHF. |
format | Online Article Text |
id | pubmed-9007481 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Via Medica |
record_format | MEDLINE/PubMed |
spelling | pubmed-90074812022-04-14 Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea Miger, Kristina Fabricius-Bjerre, Andreas Olesen, Anne Sophie Overgaard Sajadieh, Ahmad Høst, Nis Køber, Nanna Abild, Annemette Wille, Mathilde Marie Winkler Wamberg, Jesper Pedersen, Lars Schultz, Hans Henrik Lawaetz Torp-Pedersen, Christian Nielsen, Olav Wendelboe Cardiol J Clinical Cardiology BACKGROUND: Pulmonary congestion is a key component of heart failure (HF) that chest computed tomography (CT) can detect. However, no guideline describes which of many anticipated CT signs are most associated with HF in patients with undifferentiated dyspnea. METHODS: In a prospective observational single-center study, we included consecutive patients ≥ 50 years admitted with acute dyspnea to the emergency department. Patients underwent immediate clinical examination, blood sampling, echocardiography, and CT. Two radiologists independently evaluated all images. Acute HF (AHF) was adjudicated by an expert panel blinded to radiology images. LASSO and logistic regression identified the independent CT signs of AHF. RESULTS: Among 232 patients, 102 (44%) had AHF. Of 18 examined CT signs, 5 were associated with AHF (multivariate odds ratio, 95% confidence interval): enlarged heart (20.38, 6.86–76.16), bilateral interlobular thickening (11.67, 1.78–230.99), bilateral pleural effusion (6.39, 1.98–22.85), and increased vascular diameter (4.49, 1.08–33.92). Bilateral ground-glass opacification (2.07, 0.95–4.52) was a consistent fifth essential sign, although it was only significant in univariate analysis. Eighty-eight (38%) patients had none of the five CT signs corresponding to a 68% specificity and 86% sensitivity for AHF, while two or more of the five CT signs occurred in 68 (29%) patients, corresponding to 97% specificity and 67% sensitivity. A weighted score based on these five CT signs had an 0.88 area under the curve to detect AHF. CONCLUSIONS: Five CT signs seem sufficient to assess the risk of AHF in the acute setting. The absence of these signs indicates a low probability, one sign makes AHF highly probable, and two or more CT signs mean almost certain AHF. Via Medica 2022-04-07 /pmc/articles/PMC9007481/ /pubmed/35146729 http://dx.doi.org/10.5603/CJ.a2022.0004 Text en Copyright © 2022 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially |
spellingShingle | Clinical Cardiology Miger, Kristina Fabricius-Bjerre, Andreas Olesen, Anne Sophie Overgaard Sajadieh, Ahmad Høst, Nis Køber, Nanna Abild, Annemette Wille, Mathilde Marie Winkler Wamberg, Jesper Pedersen, Lars Schultz, Hans Henrik Lawaetz Torp-Pedersen, Christian Nielsen, Olav Wendelboe Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea |
title | Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea |
title_full | Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea |
title_fullStr | Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea |
title_full_unstemmed | Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea |
title_short | Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea |
title_sort | chest computed tomography features of heart failure: a prospective observational study in patients with acute dyspnea |
topic | Clinical Cardiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9007481/ https://www.ncbi.nlm.nih.gov/pubmed/35146729 http://dx.doi.org/10.5603/CJ.a2022.0004 |
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