Abstract

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.

Details

Title
Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea
Author
Miger, Kristina 1   VIAFID ORCID Logo  ; Fabricius-Bjerre, Andreas 2 ; Overgaard Olesen, Anne Sophie 2 ; Sajadieh, Ahmad 2 ; Høst, Nis 2 ; Køber, Nanna 2 ; Abild, Annemette 3 ; Winkler Wille, Mathilde Marie 4 ; Wamberg, Jesper 5 ; Pedersen, Lars 6 ; Lawaetz Schultz, Hans Henrik 6 ; Torp-Pedersen, Christian 7 ; Wendelboe Nielsen, Olav 2 

 Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Denmark. [email protected] 
 Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Denmark 
 Department of Radiology, Bispebjerg and Frederiksberg Hospital, Denmark 
 Department of Radiology, Nordsjaellands Hospital, Denmark 
 Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Denmark 
 Department of Pulmonary Medicine, Bispebjerg and Frederiksberg Hospital, Denmark 
 Department of Cardiology, Nordsjaellands Hospital, Denmark 
First page
235
End page
244
Publication year
2022
Publication date
2022
Publisher
Wydawnictwo Via Medica
ISSN
18975593
e-ISSN
1898018X
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2692718939
Copyright
© 2022. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.