Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

Abstract

BackgroundThe usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial.PurposeWe aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF.Materials and methodsWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through systematic searches of MEDLINE, EMBASE, the Cochrane Database, Google Scholar, and SinoMed. The primary outcome was MACEs (a composite of all-cause mortality, HF-related rehospitalization, and symptomatic HF). The required information size was calculated by trial sequential analysis (TSA).ResultsIn total, ten RCTs involving 1,203 patients were included. Overall, after a mean follow-up period of 4.7 months, LUS-guided treatment was associated with a significantly lower risk of MACEs than usual care [relative risk (RR), 0.59; 95% confidence interval (CI), 0.48–0.71]. Moreover, the rate of HF-related rehospitalization (RR, 0.63; 95% CI, 0.40–0.99) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration (standardized mean difference, –2.28; 95% CI, –4.34 to –0.22) were markedly lower in the LUS-guided treatment group. The meta-regression analysis showed a significant correlation between MACEs and the change in B-line count (p < 0.05). The subgroup analysis revealed that the risk of MACEs was markedly lower in patients aged up to 70 years (RR, 0.54; 95% CI, 0.44–0.67), with a lower rate of atrial fibrillation (< 27.2%) (RR, 0.53; 95% CI, 0.43–0.67), and with a lower NT-proBNP concentration (< 3,433 pg/ml) (RR, 0.51; 95% CI, 0.40–0.64). TSA indicated a lower risk of MACEs with LUS-guided treatment than with usual care among patients with HF (p < 0.05).ConclusionLung ultrasound seems to be a safe and effective method to guide HF treatment.Systematic review registration[https://inplasy.com/], identifier [INPLASY202220124].

Prognostic significance of Lung ultrasound for Heart Failure Patient Management in Primary Care. A Systematic Review

“…However, no significant differences in death rates were observed [46,47,55]. Additionally, LUS-guided treatment was associated with a lower risk of Major Adverse Cardiac Events (MACEs) [59,60]. Nonetheless, while LUS improved fluid status with a significantly greater reduction in the number of B-lines during the first 48 hours, it did not reduce heart failure readmission [53,55,62].…”

Prognostic Significance of Lung Ultrasound for Heart Failure Patient Management in Primary Care: A Systematic Review

“…However, no significant differences in death rates were observed [55][56][57]. Additionally, treatment guided by lung ultrasound (LUS) was linked to a reduced risk of Major Adverse Cardiac Events (MACEs) [58,59], and a significantly greater reduction in the number of B-lines during the initial 48 h, but it did not reduce heart failure readmission [57,60,61]. (4) The results of LUS remained independent of NT-proBNP levels [32,43,50,62].…”

Pulmonary Congestion on Lung Ultrasound Predicts Increased Risk of 30‐Day Readmission in Heart Failure Patients

“…46 A recent meta-analysis showed that LUS can help guide volume management in HF patients and reduce risk of readmission. 47,48 Although evidence suggests a benefit for LUS-guided therapy in the management of HF patients, additional studies are needed to assess the impact on survival, which decreases with each subsequent HF hospitalization, as well as hospital quality metrics and reimbursement. [49][50][51] There are several limitations of this study.…”