Prognostic value of lung ultrasound in patients hospitalized for heart disease irrespective of symptoms and ejection fraction

Abstract

Aims Lung ultrasound B-lines are the sonographic sign of pulmonary congestion and can be used in the differential diagnosis of dyspnoea to rule in or rule out acute heart failure (AHF). Our aim was to assess the prognostic value of B-lines, integrated with echocardiography, in patients admitted to a cardiology department, independently of the initial clinical presentation, thus in patients with and without AHF, and in AHF with reduced and preserved ejection fraction (HFrEF and HFpEF). Methods and resultsWe enrolled consecutive patients admitted for various cardiac conditions. Patients were classified into three groups: (i) acute HFrEF; (ii) acute HFpEF; and (iii) non-AHF. All patients underwent an echocardiogram coupled with lung ultrasound at admission, according to standardized protocols. We followed up 1021 consecutive inpatients (69 ± 12 years) for a median of 14.4 months (interquartile range 4.6-24.3) for death and rehospitalization for AHF. During the follow-up, 126 events occurred. Admission B-lines > 30, ejection fraction < 50%, tricuspid regurgitation velocity > 2.8 m/s, and tricuspid annular plane systolic excursion < 17 mm were independent predictors at multivariable analysis. B-lines > 30 had a strong predictive value in HFpEF and non-AHF, but not in HFrEF. Conclusions Ultrasound B-lines can detect subclinical pulmonary interstitial oedema in patients thought to be free of congestion and provide useful information not only for the diagnosis but also for the prognosis in different cardiac conditions. Their added prognostic value among standard echocardiographic parameters is more robust in patients with HFpEF compared with HFrEF.

Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function

“…Based on personal experiences and results of previous trials, we think that the number of USBLs can be used as a surrogate marker of cardiovascular risk and a predictor of outcomes in KTRs as well. Its diagnostic, therapeutic, and prognostic value has been demonstrated in acute and chronic heart failure [5,[36][37][38][39][40] with USBLs > 15 as a cut-off value for a poor outcome. In our cohort, moderate congestion (> 15 USBLs) was found only in six (3.8%) patients.…”

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

“…Another study with pre-discharge HF patients confirmed this cut-off irrespective of EF (29), which correlates with our findings since the best cut-off value was at 16 B lines in our cohort. B-lines also have an exceptional prognostic value, shown in patients with HF (19)(20)(21)(29)(30)(31). After a 1-year follow-up in dyspneic patients, an increased number of B-lines was associated with a higher hospitalization rate with a best cut-off at 6 B-lines (8 sector LUS) (32).…”

“…The number of B-lines is related to pulmonary capillary wedge pressure ( 16 ), NT-proBNP ( 17 ), and E/e′ in HF patients ( 18 ). LUS has a prognostic value in acute HF irrespective of EF ( 19 ) and chronic HF regardless of EF ( 20 , 21 ).…”

Value of Echocardiography in the Treatment of Patients With Acute Heart Failure

“…A recent meta-analysis reported that B-profiles identified using lung ultrasound were more accurate for detecting cardiogenic causes of dyspnea than pleural effusion and TTE (41)(42)(43). The AHF Group of the European Society of Cardiology has stated that for patients with dyspnea and shock, lung ultrasound can be easily and rapidly interpreted, and it is necessary to perform lung ultrasound, in addition to transthoracic echocardiography, in an emergent setting for patients with suspected acute heart failure (44).…”