Lung ultrasound in acute myocardial infarction. Updating Killip &amp; Kimball

Parras, Jorge I.; Onocko, Mariela; Traviesa, Liliana M.; Fernández, Eva; Morel, Pablo M.; Cristaldo, Natalia G.; Coronel, María Lorena; Macı́n, Stella M.; Perna, Eduardo R.

doi:10.1016/j.ihj.2020.11.148

Cited by 5 publications

(9 citation statements)

References 24 publications

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“…The proportion of patients with a prior diagnosis of HF was ≤ 5% in all studies. There were important differences in Killip class on admission ranging from one study including only patients without any signs of HF 13 and one study including up to 16% of patients with Killip class IV 12 . Only one study specifically excluded patients with relevant comorbidities like pulmonary infection or pulmonary fibrosis, which are known to be associated with B‐lines in the absence of HF 10 .…”

Section: Resultsmentioning

confidence: 99%

“…The included studies were conducted between 2010 and 2021 in Argentina, Brazil, China, and Italy and included a total of 1199 patients with ACS. Three studies enrolled patients with STEMI, 10–12 one patients with STEMI or NSTEMI 13 and one patients with STEMI, NSTEMI, or unstable angina 14 . One publication included 112 (51%) of patients that were also included in another analysis by this study group that is included in this review 11,12 .…”

Section: Resultsmentioning

confidence: 99%

“…Investigators used either phased array or curvilinear transducers for image acquisition. The number of LUS zones investigated was 28 zones in two studies 10,14 and eight zones in the three most recent publications 11–13 . None of the studies reported offline image analysis, that is, without blinding to clinical findings.…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies reported offline image analysis, that is, without blinding to clinical findings. B‐line quantification was assessed by summing B‐lines of each zone to a total value in two studies 10,13 and by calculating a score in three studies 11,12,14 . Only one study reported the presence of pleural effusions which were present in two patients (2%) 10 .…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence of B‐lines was reported inconsistently among the included studies due to differences in imaging protocols and quantification methods and in two publications presented by subgroups (e.g., Killip class) only 10,13 . In a study in 470 patients with STEMI, NSTEMI or unstable angina, the median number of B‐lines in 28 zones was 7 (IQR 0‐31) in LUS examinations performed within 1‐12 hours after admission 14 .…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review

et al. 2021

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Background Heart failure (HF) complicating acute coronary syndrome (ACS) is a herald of adverse outcomes. In this systematic review, we investigated the prevalence of lung ultrasound (LUS) findings and their prognostic utility among patients with ACS. Methods We searched the online databases PubMed, EMBASE, and Web of Science for studies (full‐text articles, published in English) that used LUS in adult patients with ACS [ST‐elevation myocardial infarction (STEMI), non‐ST‐elevation myocardial infarction (NSTEMI), and unstable angina]. Results Of 462 studies screened, five prospective, observational investigations published between 2010 and 2021 including 1087 patients met our inclusion criteria. Two studies employed 28‐zone imaging protocols whereas three used eight‐zone protocols. The proportion of patients with a prior HF diagnosis was ≤ 5% in all studies. The prevalence of B‐lines was examined prior to or within 12 hours after coronary angiogram and reporting varied between studies due to different imaging protocols or quantification methods. A higher number of B‐lines on admission was associated with an increased risk for developing symptomatic HF during the baseline hospitalization and with a higher in‐hospital mortality rate using either 8 or 28‐zone protocols. A higher number of B‐lines at baseline was also associated with an increased risk of subsequent HF hospitalization or all‐cause death. Conclusions Pulmonary congestion by LUS performed on admission appears to be a common finding among patients hospitalized for ACS and is associated with adverse in‐hospital and long‐term outcomes. Further investigations using standardized LUS protocols are warranted and have the potential to improve risk stratification in ACS.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review

et al. 2021

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Trajectory and correlates of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction: insights from PARADISE-MI

Platz

Claggett

Jering

et al. 2023

European Heart Journal: Acute Cardiovascular Care

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Background PARADISE-MI examined the efficacy of sacubitril/valsartan in acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both. We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a prespecified substudy. Methods Patients without prior heart failure (HF) underwent 8-zone LUS and echocardiography at baseline (±2 days of randomization) and after 8 months. B-lines were quantified offline, blinded to treatment, clinical findings, timepoint and outcomes. Results Among 152 patients (median age 65, 32% women, mean LVEF 41%), B-lines were detectable in 87% at baseline (median B-line count: 4 [IQR 2-8]). Among 115 patients with LUS data at baseline and follow-up, B-lines decreased significantly from baseline (mean ± SD: -1.6 ± 7.3; p=0.018). The proportion of patients without pulmonary congestion at follow-up was significantly higher in those with fewer B-lines at baseline. Adjusted for baseline, B-lines at follow-up were on average 6 (95% CI: 3, 9) higher in patients who experienced an intercurrent HF event vs. those who did not (p=0.001). A greater number of B-lines at baseline was associated with larger left atrial size, higher E/e’ and E/A ratios, greater degree of mitral regurgitation, worse right ventricular systolic function, and higher tricuspid regurgitation velocity (p trend <0.05 for all). Conclusions In this AMI cohort, B-lines, indicating pulmonary congestion, were common at baseline and, on average, decreased significantly from baseline to follow-up. Worse pulmonary congestion was associated with prognostically important echocardiographic markers.

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Subclinical congestion assessed by lung ultrasound in ST segment elevation myocardial infarction

Carreras-Mora

Simon-Ramon

Vidal-Burdeus

et al. 2023

Heart

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ObjectiveWe evaluated the prognostic value of subclinical congestion assessed by lung ultrasound (LUS) in patients admitted for ST segment elevation myocardial infarction (STEMI).MethodsThis was a multicentre study that prospectively enrolled 312 patients admitted for STEMI without signs of heart failure (HF) at admission. LUS was performed during the first 24 hours after revascularisation and classified patients as having either wet lung (three or more B-lines in at least one lung field) or dry lung. The primary endpoint was a composite of acute HF, cardiogenic shock or death during hospitalisation. The secondary endpoint was a composite of readmission for HF or new acute coronary syndrome or death during 30-day follow-up. Zwolle score was calculated in all patients to assess predictive improvement by adding the result of the LUS to this score.Results14 patients (31.1%) in the wet lung group presented the primary endpoint vs 7 (2.6%) in the dry lung group (adjusted RR 6.0, 95% CI 2.3 to 16.2, p=0.007). The secondary endpoint occurred in five patients (11.6%) in the wet lung group and in three (1.2%) in the dry lung group (adjusted HR 5.4, 95% CI 1.0 to 28.7, p=0.049). Addition of LUS improved the ability of the Zwolle score to predict the follow-up composite endpoint (net reclassification improvement 0.99). LUS showed a very high negative predictive value in predicting in-hospital and follow-up endpoints (97.4% and 98.9%, respectively).ConclusionEarly subclinical pulmonary congestion identified by LUS in patients with Killip I STEMI at hospital admission is associated with adverse outcomes during hospitalisation and 30-day follow-up.

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Lung ultrasound in acute myocardial infarction. Updating Killip & Kimball

Cited by 5 publications

References 24 publications

Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review

Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review

Trajectory and correlates of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction: insights from PARADISE-MI

Subclinical congestion assessed by lung ultrasound in ST segment elevation myocardial infarction

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