Assessment of early treatment response by rapid cardiothoracic ultrasound in acute heart failure: Cardiac filling pressures, pulmonary congestion and mortality

Abstract

E/e' seemed like the most useful congestion parameter for monitoring early treatment response, predicting prognostically beneficial resolution of pulmonary congestion.

Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…In a single-centre study of 60 patients, the significant decrease in E/e ′ was observed as early as within the first 12 h of treatment with further decline during 48 h, contrary to the delayed response of inferior vena cava (IVC) and BNP values. 106 Change in pulmonary capillary occluded pressure was strongly correlated with change in E/e ′ at 48 h but not with BNP in 50 patients admitted to intensive care, 94 although many factors other than left atrial pressure can affect BNP levels. Non-invasive indices should be used cautiously in patients with heart failure with preserved ejection fraction because of the high variability of individual linear regression slopes relating E/e ′ and E/Vp with invasive measures.…”

“…B‐lines appear to be dynamic in nature, as they decrease in proportion to the amount of fluid removed in patients undergoing dialysis . They have also been shown to decrease with treatment of AHF . According to a recent systematic review, B‐line number changed within as few as 3 h of heart failure treatment .…”

Usefulness of inferior vena cava ultrasonography in outpatients with chronic heart failure

“…Besides, in ADHF patients, IVC diameter at admission has shown prognosis utility for readmission, renal impairment, and mortality . IVC diameter has been correlated with the clinical evolution of ADHF, showing improvement in diameter and collapsibility after diuretic treatment . Finally, other studies have demonstrated the prognosis power of IVC ultrasonography, prior to discharge after hospitalization for ADHF, to predict readmission …”

The lung water cascade in heart failure

“…Ohman et al measured B‐lines, natriuretic peptides, and dyspnea serially after pulmonary decongestion therapy with diuretics. Patients showing an early reduction of E/eʹ also showed a more marked reduction in B‐lines, which was the strongest prognostic predictor, again suggesting that LUS may provide a suitable marker to study the pulmonary congestion and also the therapy‐induced pulmonary decongestion phase . The proposed model of lung water cascade needs now further evidence support through prospective studies looking more systematically to the sequence of events both in pulmonary congestion and pulmonary decongestion phase.…”

“…ured B-lines, natriuretic peptides, and dyspnea serially after pulmonary decongestion therapy with diuretics. Patients showing an early reduction of E/eʹ also showed a more marked reduction in B-lines, which was the strongest prognostic predictor, again suggesting that LUS may provide a suitable marker to study the pulmonary congestion and also the therapy-induced pulmonary decongestion phase 38. The proposed model of lung water cascade needs now further evidence support through prospective studies looking more systematically to the sequence of events both in pulmonary congestion and pulmonary decongestion phase.The stage is set for outcome studies comparing standard vs B-line-driven therapy in heart failure in various populations, including heart failure with reduced or preserved ejection fraction; patients with rest or only exercise-induced B-lines; with or without chronic renal failure, and so on.…”