Lung ultrasound-guided therapeutic thoracentesis in refractory congestive heart failure

Abstract

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\u2009±\u200912%), New York Heart Association class ≥3, and pleural effusion\u2009≥\u2009moderate 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\u2009±\u2009534\u2009mL. The maximal interpleural space was 73.6\u2009±\u200915.6\u2009mm before, and 12.4\u2009±\u20093.1\u2009mm after therapeutic thoracentesis (p\u2009<\u2009.001). Therapeutic thoracentesis induced an immediate symptomatic improvement in all patients, with New York Heart Association class decrease from 3.84\u2009±\u20090.37 pre- to 2.7\u2009±\u20090.55 post-therapeutic thoracentesis (p\u2009<.001). The improvement was long-lasting (for weeks/months) in 89% of patients. The 6-min walking test was 52\u2009±\u200929 m before, and 287\u2009±\u200956 m one month after therapeutic thoracentesis (p\u2009<\u2009.05). 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.