Abstract:AimsIn ambulatory patients with chronic heart failure (HF), congestion and decongestion assessment may be challenging. The aim of this study is to assess the value of lung ultrasound (LUS) in outpatients with HF in characterizing decompensation and recompensation, and in outcomes prediction.
Methods and resultsHeart failure outpatients attended to establish HF decompensation were included. LUS was blindly performed at baseline (LUS1) and at clinical recompensation (LUS2). B-lines were counted in eight scanned … Show more
“…Pulmonary congestion (PC) is one of the major characteristics of HF [ 6 , 7 , 8 ]. The importance of PC in the disease course of HF has been confirmed by numerous clinical trials, and the presence of PC is shown to be associated with a significantly increased risk of mortality and rehospitalization in HF patients [ 6 , 9 ]. Multiple studies have demonstrated the usefulness of assessment of pulmonary congestion from a prognostic point of view.…”
Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139–0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.
“…Pulmonary congestion (PC) is one of the major characteristics of HF [ 6 , 7 , 8 ]. The importance of PC in the disease course of HF has been confirmed by numerous clinical trials, and the presence of PC is shown to be associated with a significantly increased risk of mortality and rehospitalization in HF patients [ 6 , 9 ]. Multiple studies have demonstrated the usefulness of assessment of pulmonary congestion from a prognostic point of view.…”
Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139–0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.
“…The prognostic significance of the number of B-lines varied across studies. Most studies indicated that a sum of ≥5 B-lines was associated with a higher probability of 12-month all-cause death, and ≥15 B-lines with higher probability of HF readmission [45,[50][51][52]56,61,65]. Others [57] suggested that the presence of 30-40 B-lines at admission was a risk factor for readmission or mortality, and the presence of ≥15 B-lines could indicate just an increased risk of persistent pulmonary congestion.…”
Heart failure (HF) affects about 60 million people worldwide, making it one of the chronic conditions with the greatest health and economic impact. The primary objective was to assess the efficacy of lung ultrasound (LUS) in the management of HF in order to intervene early and reduce the rate of hospital readmissions. A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, including clinical trials, meta-analysis, systematic reviews, and original articles from 2019/1/1-2023/12/31, about LUS for the assessment of HF, on an outpatient basis, for HF diagnosis or/and decompensation. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 873 articles were identified of which 33 articles were selected: [n=19] focused on prognostic assessment of HF, [n=11] centred on multimodal diagnostic assessments, and [n=2] addressing therapeutic guidance for HF diagnosis. LUS exhibits advantages in the detection of sub-clinical congestion linked to prognostic significance in re-admission and mortality during out-patient follow-up, after hospital discharge, and in complex scenarios as the patients' homes or institutional long-term care facilities. However, there are considerable uncertainties in their interpretation and monitoring changes due to its lack of standardization. The need for an updated international consensus on the use of LUS seems obvious.
“…In der ambulanten Versorgung von Patienten mit chronischer Herzinsuffizienz chronischer Herzinsuffizienz zeigt LUS eine prognostische Bedeutung für den Tod und eine herzinsuffizienzbedingte Hospitalisierung sowohl nach 30 Tagen wie auch nach 32 Monaten. Hierbei korreliert die Anzahl der B‑Linien in einem 8‑Zonen-Protokoll mit einer erhöhten Mortalität [ 30 , 31 ].…”
Section: Lungensonographie In Der Ambulanten Versorgungunclassified
Die Lungensonographie (LUS) hat sich in den letzten Jahren als evidenzbasierte Untersuchungsmethode auch in der kardiologischen Intensiv- und Notfallmedizin etabliert, ihr Beherrschen wird in einem Positionspapier von der DGIIN (Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin), DEGUM (Deutsche Gesellschaft für Ultraschall in der Medizin) und DGK (Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V.) vorausgesetzt. Im Gegensatz zur konventionellen Sonographie beruht LUS primär auf einer Artefaktanalyse, eine morphologisch-anatomisch korrekte Organdarstellung ist nur bei der pathologisch veränderten konsolidierten Lunge möglich. Als schnell anwendbare Technik bietet sie sich in der Point-of-care-Diagnostik beim Leitsymptom Dyspnoe an. Die Korrelation von LUS-Befunden mit dem pulmonalen Flüssigkeitsgehalt und dem pulmonalkapillären Verschlussdruck erlaubt eine zeitnahe nichtinvasive Abschätzung und damit die Erhebung oft therapieentscheidender Befunde für die Behandlung kritisch kranker Patienten. Trotz einer Vielzahl beschriebener Methoden, eine pulmonale Überwässerung mittels LUS zu quantifizieren, besteht aktuell kein Konsens über die geeignetste Methode und daher auch keine Standardisierung.
Video online
Die Online-Version dieses Beitrags (10.1007/s12181-023-00606-3) enthält weitere Videos. Video 1: Systematik der LUS-Befunde in Anlehnung an D. Lichtenstein. Video 2: Beidseitige B‑Linien-Zunahme bei Lungenödem.
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