Lung Ultrasound in Acute Heart Failure

Platz, Elke; Campbell, Ross T.; Claggett, Brian; Lewis, Eldrin F.; Groarke, John D.; Docherty, Kieran F.; Lee, Matthew M Y; Merz, Allison A.; Silverman, Montane B; Swamy, Varsha; Lindner, Moritz; Rivero, Jose; Solomon, Scott D.; McMurray, John J.V.

doi:10.1016/j.jchf.2019.07.008

Cited by 134 publications

(134 citation statements)

References 19 publications

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“…5 We retrospectively performed correlation analyses between 4-point, 8-point, and 28-point lung ultrasound protocols, and have presented methodology and results in Supplementary Material. [35][36][37] Our data suggest that both the 4-point and 8-point ultrasound protocols correlated well with the 28-point protocol. It is uncertain, however, whether a simplified lung ultrasound protocol can fully replace the 28-point protocol, given the degree of quantification required to guide minute dry weight titration.…”

Section: Discussionsupporting

confidence: 54%

“…5 A 4-zone lung ultrasound has been demonstrated to be adequate for detection and quantification of extravascular lung water in acute heart failure, as well as in the critical care setting. 35,36 However, the prognostic significance and clinical utility of these protocols have not been studied in the ESKD cohort. 5 We retrospectively performed correlation analyses between 4-point, 8-point, and 28-point lung ultrasound protocols, and have presented methodology and results in Supplementary Material.…”

Section: Discussionmentioning

confidence: 99%

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Comparison between lung ultrasonography and current methods for volume assessment in Asian chronic hemodialysis patients

Ngoh

Teng

Chua

et al. 2020

Hemodialysis International

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Introduction: Volume assessment in end-stage kidney disease patients on hemodialysis (HD) remains inadequate by existing methods: clinical examination, bioimpedance spectroscopy, measurement of inferior vena cava diameter by ultrasound (IVCD), and plasma B-type natriuretic peptide (NT-pro BNP). This study aims to compare the performance of lung ultrasound against existing methods for volume assessment in a HD cohort. Methods: Two nephrologists independently performed 28-point lung ultrasound immediately before and after midweek HD in 50 patients. Lung congestion was classified into mild, moderate, and severe categories based on lung ultrasound findings. Clinical examination for crepitations and oedema, change in hydration status (ΔHS) measured by bioimpedance spectroscopy, NT-pro BNP, IVCD during inspiration (IVCDimin), expiration (IVCDimax), and inferior vena cava collapsibility index were also assessed before and after midweek HD. Findings: In all, 61% of patients with normohydration status by bioimpedance spectroscopy had moderate or severe lung congestion on lung ultrasound. There were significant correlations between predialysis lung ultrasound, and NT-pro BNP (r = 0.432, P = 0.004), ΔHS (r = 0.447, P < 0.001), and IVCD parameters (P < 0.05). Some correlations weakened postdialysis (ΔHS [r = 0.322, P = 0.01] and IVCDimax [r = 0.307, P = 0.03]), whereas NT-pro BNP and ΔHS paradoxically increased in 28% and 30% of the cohort, respectively. On receiver operator curve analysis, most methods of volume assessment had limited discriminatory power to detect mild lung congestion. Discussion: Lung ultrasound demonstrates some comparability with existing volume assessment methods in Asian dialysis patients. However, it appears more effective at detecting subclinical pulmonary congestion, and tracking fluid changes real-time compared to bioimpedance spectroscopy and NT-pro BNP.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Comparison between lung ultrasonography and current methods for volume assessment in Asian chronic hemodialysis patients

Ngoh

Teng

Chua

et al. 2020

Hemodialysis International

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“…Thus, LUS emerges as a promising predictive test easy to perform, non-invasive, and cheap. Indeed, several studies have reported the prognostic capacity of the presence of B-lines in HF, [7][8][9][10][18][19][20][21][22][23] although none of them has analysed the performance of B-lines in the absence of other markers of HF congestion. To the best of our knowledge, this is the first study showing the prognostic capacity of the presence of B-lines in patients in whom their treating physicians considered them properly lung decongested.…”

Section: Prognosis Of Residual Congestion In Heart Failurementioning

confidence: 99%

“…The number of B-lines has been found to be a reliable indicator of the presence of extravascular lung water and has allowed the identification of heart failure (HF) patients with a worse prognosis. [7][8][9][10] In addition, the LUS-HF trial has recently showed that the assessment of pulmonary congestion by LUS helps to guide treatment in patients with HF and to improve their prognosis. 11 However, there is a paucity of data about the prevalence of subclinical pulmonary congestion and its potential prognostic impact in patients discharged without clinically lung fluid overload.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure

et al. 2020

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Aims Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in patients admitted for acute HF. Methods and results This is a post-hoc analysis of the LUS-HF trial. LUS was performed by the investigators in eight chest zones with a pocket device. Physical exam was subsequently performed by the treating physicians. Primary outcome was a combined endpoint of rehospitalization, unexpected visit for HF worsening or death at 6month follow-up. Subclinical pulmonary congestion at discharge was defined as the presence of ≥5 B-lines in LUS in absence of rales in the auscultation employing the area under the ROC curve. At discharge, 100 patients (81%) did not show clinical signs of pulmonary congestion. Of these, 41 had ≥5 B-lines. Independent factors related with the presence of subclinical pulmonary congestion were anaemia, higher New York Heart Association (NYHA) class, and N terminal pro brain natriuretic peptide (NT-proBNP). After adjusting by propensity score analysis including age, renal insufficiency, atrial fibrillation, NYHA class, NT-proBNP levels, clinical congestion, and the trial intervention, the presence of subclinical pulmonary congestion at discharge was a risk factor for the occurrence of the primary outcome (hazard ratio 2.63; 95% confidence interval: 1.08-6.41; P = 0.033). Conclusions Up to 40% of patients considered 'dry' according to pulmonary auscultation presents subclinical congestion at hospital discharge that can be detected by LUS and implies a worse prognosis at 6month follow-up. Comorbidities, high values of natriuretic peptides, and higher NYHA class are the factors related with its presence.

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“…Однако данная методика представляется достаточно трудоемкой и относительно времязатратной (хотя здесь следует отметить, что продолжительность даже такого исследования ограничена 5-10 мин). Сегодня же в описании методики УЗИ легких все чаще можно увидеть рекомендацию проведения исследования со сканированием 8 и 4 зон [21][22][23] (рис. 3), что обусловлено высокой корреляцией результатов при сканировании 28 и меньшего (8 или 4) количества зон [24].…”

Section: ультразвуковое исследование легких у пациентов с хснunclassified

Lung ultrasound in optimizing management of patients with heart failure: current status and future prospects

et al. 2020

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Lung Ultrasound in Acute Heart Failure

Cited by 134 publications

References 19 publications

Comparison between lung ultrasonography and current methods for volume assessment in Asian chronic hemodialysis patients

Comparison between lung ultrasonography and current methods for volume assessment in Asian chronic hemodialysis patients

Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure

Lung ultrasound in optimizing management of patients with heart failure: current status and future prospects

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