Impact of Large-Volume Pleural Effusions on Heart Function

Study Overview
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Brief Summary
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The physiologic basis for relief from dyspnea after therapeutic thoracentesis remains poorly understood. Improvement of the heart and lung function may contribute to the dyspnea relief. But there is no data support this phenomenon. Transthoracic echocardiogram (TTE) is a non-invasive viewing of the heart, which can quickly assess the heart function through real-time images. The investigators performed thoracentesis on patients with large-volume pleural effusions, and utilized TTE to access the change of heart and lung function before and after this medical procedure.

Detailed Description
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Patients with large pleural effusions often experience dramatic and immediate relief from dyspnea after therapeutic thoracentesis. Although this is a well-recognized phenomenon, the physiologic basis for such relief remains poorly understood. Primary physiologic basis for the relief in dyspnea after thoracentesis may include the improvement of the heart and lung function. In some cases the improvement in breathlessness cannot be attributed to the improvement of gas exchange, due to the atelectatic lung(not fully expansion of the lung). Transthoracic echocardiogram (TTE) is a non-invasive, real-time viewing of the internal parts of the heart using ultrasound, which can get highly accurate and quick assessment of the various heart images, though which doctors can quickly assess a patient's heart valves and degree of heart muscle contraction.

Official Title
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The Assessment of Heart Function Using Transthoracic Echocardiogram (TTE) Following Thoracentesis on Large-volume Pleural Effusions

Conditions
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Bilateral Pleural Effusion

Intervention / Treatment
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* Device: transthoracic echocardiogram


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: the estimated amount of effusion is above 500 ml; Drainage was not performed within 1 month before admission; assigned informed consent. Exclusion Criteria: physical weakness which is difficult to withstand the thoracentesis; the happening of serious pleural reaction or reexpansion pulmonary edema on previous thoracentesis; allergy to the anesthetic; coagulation dysfunction, severe bleeding tendency; serious mental illness who do not cooperate; suspected with pleural hydatid disease; skin infection around supine positioning; severe heart function insufficiency who cannot lay on the back; for a variety of reasons that cannot accept regular follow-up; refused to sign the informed consent; other conditions that is not suitable for the test.

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: transthoracic echocardiogram|Thoracentesis was performed on patients with large-volume pleural effusions, and TTE was utilized to access the change of heart and lung function before and after this medical procedure.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| changes of the TTE diameter after large-volume thoracentesis | change of the UCG diameter of the patients, including : Left ventricular: Left ventricular end-diastolic diameter(LVEDD）, Left ventricular end-systolic diameter（LVESD）, Left ventricular end-diastolic volume （LVEDV ）, Left ventricular end-systolic volume（ LVESV）, Left ventricular ejection fraction（LVEF）,Stroke volume（SV）,Cardiac output（CO），left ventricular diastolic function, including：E、A、E/A、E/Em、Em、Am（By PW&DTI）；Global longitudinal strain(GLS）; right ventricular：Basal and mid-cavity transversal right ventricular diameter, right ventricular free wall thickness, Tricuspid annular plane systolic excursion（TAPSE）, Fractional area change（FAC）, right ventricular systolic strain, Left and right atrial volume, coronary artery diameter | baseline, immediately after drainage, 24 h after the thoracentesis | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| changes of the distances on 6-MWT after large-volume thoracentesis | 6-MWT is the distances on the 6-minute walk test | baseline, immediately after drainage, 24 h after the thoracentesis | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Thoracentesis, Pleural Effusions, Transthoracic echocardiogram, Lung volume measurements