Lazarevic, Aleksandar (6603842010)Aleksandar (6603842010)LazarevicDobric, Milan (23484928600)Milan (23484928600)DobricGoronja, Boris (57195732652)Boris (57195732652)GoronjaTrninic, Dijana (56009277500)Dijana (56009277500)TrninicKrivokuca, Svetozar (57208149674)Svetozar (57208149674)KrivokucaJovanic, Jelena (57208145788)Jelena (57208145788)JovanicPicano, Eugenio (7102408994)Eugenio (7102408994)Picano2025-06-122025-06-122020https://doi.org/10.1080/00015385.2019.1591677https://www.scopus.com/inward/record.uri?eid=2-s2.0-85063970322&doi=10.1080%2f00015385.2019.1591677&partnerID=40&md5=b8404d2952da8f607c1cf2661adcc3c6https://remedy.med.bg.ac.rs/handle/123456789/4668Background: 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 ± 12%), New York Heart Association class ≥3, and pleural effusion ≥ moderate 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 ± 534 mL. The maximal interpleural space was 73.6 ± 15.6 mm before, and 12.4 ± 3.1 mm after therapeutic thoracentesis (p <.001). Therapeutic thoracentesis induced an immediate symptomatic improvement in all patients, with New York Heart Association class decrease from 3.84 ± 0.37 pre- to 2.7 ± 0.55 post-therapeutic thoracentesis (p <.001). The improvement was long-lasting (for weeks/months) in 89% of patients. The 6-min walking test was 52 ± 29 m before, and 287 ± 56 m one month after therapeutic thoracentesis (p <.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. © 2019 Belgian Society of Cardiology.Heart failurelung ultrasoundpleural effusionthoracentesis