Valvular & structural heart disease
Pleural Effusion in Severe Aortic Stenosis: Marker of an Adverse Haemodynamic Constellation and Poor Prognosis
Authors' conclusion
In severe AS patients, the presence of PE, particularly bilateral PE, is a marker of a poor haemodynamic constellation. Bilateral PE is associated with a substantially increased post-AVR mortality.
Study context
- Population
- Patients with severe aortic stenosis (AS) undergoing right heart catheterization and upright CXR before aortic valve replacement (AVR)
- Participants
- 471 patients
- Exposure
- Bilateral pleural effusion (PE) vs unilateral PE vs no PE
- Bilateral PEn = 49
- Unilateral PEn = 32
- No PEn = 390reference
- Outcome
- Haemodynamic correlates and prognostic impact (mortality) of PE
- Follow-up
- Median post-AVR 1361 (957-1878) days
Methodological detailsblinded CXR assessment by 2 radiologists
- Blinded CXR assessment by 2 radiologists
Main finding
As reported in the abstract
Post-AVR mortality · median 1361 (957-1878) days
- Mortality highest with bilateral PE (2.7 times higher than no PE)
- Unilateral PE: similar mortality as no PE
Observational data: associations, not effects.
Further findings
Haemodynamics
- Bilateral PE: highest mean right atrial pressure, mean pulmonary artery wedge pressure (mPAWP) and pulmonary vascular resistance, lowest stroke volume index; unilateral PE intermediate
- mPAWP independent predictor of any PE and bilateral PE (multivariate analysis)
Original publication
Pleural Effusion in Severe Aortic Stenosis: Marker of an Adverse Haemodynamic Constellation and Poor Prognosis. ESC Heart Fail. Published 10 January 2024. doi:10.
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