Estudio RAD-ICA: valor pronóstico de la radiografía de tórax obtenida en urgencias en pacientes con insuficiencia cardiaca aguda

espanolObjetivos. Investigar si la radiografia de torax en pacientes con insuficiencia cardiaca aguda (ICA) puede contribuir a establecer el pronostico. Metodo. Se incluyeron pacientes consecutivos diagnosticados de ICA en urgencias. Se valoro: cardiomegalia radiologica (CR), derrame pleural (DP) y el patron parenquimatoso pulmonar (PPP: redistribucion vascular, edema intersticial, edema alveolar). Se recogieron variables del estado basal del paciente y del episodio. Las variables de resultado evaluadas fueron mortalidad intrahospitalaria y al ano, ingreso prolongado (> 7 dias) y evento combinado (reconsulta, rehospitalizacion o muerte) a 30 dias postalta, para las cuales se calcularon las hazard ratio crudas y ajustadas para las tres variables radiologicas y su combinacion entre ellas. Resultados. Se incluyeron 2.703 pacientes con una edad media de 81 (DE 19) anos; el 54,5% eran mujeres. Se observo CR en 1.711 casos (76,8%), DP en 992 (36,7%) y todos los pacientes mostraron PPP (redistribucion vascular el 61,9%, edema intersticial el 23,3% y edema alveolar el 14,9%). El analisis ajustado mostro que la CR no tuvo valor pronostico; el DP incremento un 23% (IC 95% 2-49%) los eventos combinados a los 30 dias postalta; y el PPP edema alveolar aumento un 89% (30-177%) la mortalidad intrahospitalaria y un 38% (14-67%) la mortalidad al ano respecto al PPP redistribucion vascular (referencia). El estudio de la combinacion de estos tres hallazgos radiologicos mostro resultados similares y congruentes con los hallazgos del estudio individualizado. Conclusiones. La radiografia de torax, ademas de ayudar a establecer el diagnostico de ICA, puede contribuir a estimar el pronostico de eventos adversos. Asi, el DP se asocia a un incremento de eventos adversos postalta y el PPP edema alveolar a una mayor mortalidad. EnglishObjective. 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 30- day 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.