Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study

Gargani, Luna; Pang, Peter S.; Frassi, Francesca; Miglioranza, Marcelo Haertel; Dini, Fl; Landi, Patrizia; Picaño, Eugenio

doi:10.1186/s12947-015-0033-4

Cited by 179 publications

(195 citation statements)

References 56 publications

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“…Supplemental Table 6 provides criteria from multiple acute HF, global HF, and non-HF sources to aid in determining the timing of consultation in CS. 15,278,[295][296][297][298][299][300][301][302][303][304][305][306][307][308][309][310] We suggest that the multidisciplinary assessment team include a palliative care physician, regardless of MCS candidacy, given the risk of peri-implantation death.…”

Section: Suggestions For Clinical Carementioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,189

1,120

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Section: Suggestions For Clinical Carementioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,189

1,120

View full text Add to dashboard Cite

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“…Our findings are in line with previous studies, which demonstrated that the results of LUS are highly correlated with the increased NT-proBNP levels at discharge. This is an important fact, having in mind the data confirming that the presence of (subclinical) congestion at discharge, demonstrated by LUS, is a good predictor of hospital readmissions [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

The Value of a Simplified Lung Ultrasound Protocol in the Pre-Discharge Evaluation of Patients Hospitalized with Acute Heart Failure

Frigy

Kocsis

Fehérvári

et al. 2016

Acta Medica Marisiensis

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Optimal timing of hospital discharge in patient with acute heart failure (AHF) is an important factor of preventing rehospitalizations. Aim. To evaluate the value of a simplified lung ultrasound (LUS) protocol in assessing pre-discharge status of patients with AHF, correlating the US findings with the values of NT-proBNP levels. Methods. 24 patients (18 men, 6 women, mean age 68,2 years) hospitalized with acute heart failure underwent LUS examination in the afternoon of the day before hospital discharge, applying a simplified LUS protocol, using three basal examination areas on the right side (anterior, lateral and posterior) and two basal examination areas on the left side (lateral and posterior). The LUS score was represented by the sum of B lines. In the next morning the value of NT-proBNP was also determined. The correlation between LUS findings and NT-proBNP values was analyzed using Fisher`s exact test (significant if alpha<0,05). Results. 6 patients had <15 B lines, 16 patients had >15 B lines and 2 patients had pleural effusion on LUS, while 16 patients had the value of NT-proBNP >1000pg/ml at discharge. The results of LUS examination correlated significantly (p=0.0013) with the NT-proBNP values -only one patient not having increased NT-proBNP in the group with >15 B lines. Conclusions. Despite a relatively good clinical status, the majority of patients had high NT-proBNP values at the time of hospital discharge. LUS proved to be a useful tool in identifying patients with subclinical congestion reflected also by the high NT-proBNP levels. These patients may need a prolongation of hospitalization and/or a more careful follow-up to prevent early readmission.

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“…Lung ultrasound 6 (LUS) has emerged in medicine as a readily available, highly reproducible and efficient 7 method for the assessment of pulmonary congestion. [8][9][10][11][12] LUS is especially useful to 8 determine pulmonary oedema and pleural effusion, which are common manifestations 9 of HF. 9,11,13 However, to our knowledge LUS has not been used to detect HF in mouse 10 models of cardiac disease.…”

mentioning

confidence: 99%

“…9,11,13 However, to our knowledge LUS has not been used to detect HF in mouse 10 models of cardiac disease. Here we provide for first time a translational non-invasive 11 method based on combined echocardiography and LUS that enables researchers to study 12 HF progression in mouse models of systolic and diastolic dysfunction and to evaluate 13 the efficacy of treatments for this syndrome.…”

mentioning

confidence: 99%

Lung ultrasound as a translational approach for non-invasive assessment of heart failure with reduced or preserved ejection fraction in mice

Villalba-Orero

López-Olañeta

González-López

et al. 2017

Cardiovascular Research

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1Aims─ Heart failure (HF) has become an epidemic and constitutes a major medical, 2 social and economic problem worldwide. Despite advances in medical treatment, HF 3 prognosis remains poor. The development of efficient therapies is hampered by the lack 4 of appropriate animal models in which HF can be reliably determined, particularly in 5 mice. The development of HF in mice is often assumed based on the presence of cardiac 6 dysfunction, but HF itself is seldom proved. Lung ultrasound (LUS) has become a 7 helpful tool for lung congestion assessment in patients at all stages of HF. We aimed to 8 apply this non-invasive imaging tool to evaluate HF in mouse models of both systolic 9 and diastolic dysfunction.

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Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study

Cited by 179 publications

References 56 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

The Value of a Simplified Lung Ultrasound Protocol in the Pre-Discharge Evaluation of Patients Hospitalized with Acute Heart Failure

Lung ultrasound as a translational approach for non-invasive assessment of heart failure with reduced or preserved ejection fraction in mice

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