Lung ultrasound and biomarkers in primary care: Partners for a better management of patients with heart failure?

Abstract

Introduction: The association of pulmonary congestion assessed by lung ultrasound (LUS) and biomarkers—other than N-terminal pro-brain natriuretic peptide (NT-proBNP)—is uncertain.
 Methods: We investigated the relationship between total B-line count by LUS and several biomarkers in outpatients with suspicion of heart failure (HF). Primary care patients with suspected new-onset nonacute HF were evaluated both with a 12-scan LUS protocol (8 anterolateral areas plus 4 lower posterior thoracic areas) and 11 inflammatory and cardiovascular biomarkers. A cardiologist blinded to LUS and biomarkers except NT-proBNP confirmed HF diagnosis. After log-transformation of biomarkers’ concentrations, unadjusted and adjusted correlations were performed.
 Results: A total of 170 patients were included (age 76 ± 10 years, 67.6% women). HF diagnosis was confirmed in 38 (22.4%) patients. After adjustment by age, sex, body mass index, and renal function, total B-line sum significantly correlated with NT-proBNP (R = 0.29, p < 0.001), growth/differentiation factor-15 (GDF-15; R = 0.23, p = 0.003), high-sensitive Troponin T (hsTnT; R = 0.36, p < 0.001), soluble interleukin-1 receptor-like 1 (sST2; R = 0.29, p < 0.001), cancer antigen 125 (CA-125; R = 0.17, p = 0.03), high-sensitivity C-reactive protein (hsCRP; R = 0.20, p = 0.009), and interleukin (IL)-6 (R = 0.23, p = 0.003). In contrast, IL-33 (R = −0.01, p = 0.93), IL-1β (R = −0.10, p = 0.20), soluble neprilysin (sNEP; R = 0.09, p = 0.24), tumor necrosis factor-alpha (TNF-α; R = 0.07, p = 0.39), and TNF-α receptor superfamily member 1A (TNFRSF1A; R = 0.14, p = 0.07) did not.
 Conclusions: Total B-line sum correlated significantly, although moderately, with congestion and several inflammation biomarkers. Unexpectedly, the highest correlation found was with hsTnT.

The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial

“…In relation to the prognostic value of NT-proBNP in this study, through ROC curve analysis, the probability of predicting admission and cardiovascular death this was evaluatedm and we observed that values above 3000 pg/mL were quite likely to predict the primary endpoint. These results are similar to previous reports [ 27 , 28 , 29 ].…”

Lung ultrasound in outpatients with heart failure: the wet‐to‐dry HF study

“…Although LUS and CA125 are both congestion and short‐term prognostic markers, 34,35 there is little evidence of their association in acute and chronic HF. Our finding supports hypothesized correlations between B‐lines and cardiac biomarkers other than CA125 in HF patients, as we have previous reported 36 …”

“…Our finding supports hypothesized correlations between B‐lines and cardiac biomarkers other than CA125 in HF patients, as we have previous reported. 36 …”

New International Guidelines and Consensus on the Use of Lung Ultrasound

“…The use of LUS at the stage of outpatient diagnostics is beneficial for not only the patient and physician, indeed given its cost‐effectiveness it should also be viewed in light of its potential for health care system costs reduction 173–175 . Numerous examples of the use of US in the diagnostics of adults and children in outpatient treatment and even during home visits have been described 176–183 . The use of US in the GP office reduces the time to make an accurate diagnosis, helps in making therapeutic decisions and may improve the patient's prognosis 184,185 .…”

“… 173 , 174 , 175 Numerous examples of the use of US in the diagnostics of adults and children in outpatient treatment and even during home visits have been described. 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 The use of US in the GP office reduces the time to make an accurate diagnosis, helps in making therapeutic decisions and may improve the patient's prognosis. 184 , 185 Moreover, LUS used as point‐of‐care examination method may reduce disproportions in the quality of medical services depending on the place of residence and reduce the costs of patient care.…”