Prognostic value of lung ultrasound in chronic stable ambulatory heart failure patients

Domingo, Mar; Conangla, Laura; Lupón, Josep; Antonio, Marta de; Moliner, Pedro; Santiago‐Vacas, Evelyn; Codina, Pau; Zamora, Elisabet; Cediel, Germán; González, Beatríz; Díaz, Violeta; Rivas, Carmen; Velayos, P; Santesmases, Javier; Pulido, Ana; Crespo, Estefanía Luque; Bayés‐Genís, Antoni

doi:10.1016/j.rec.2020.07.006

Cited by 8 publications

(15 citation statements)

References 25 publications

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“…In this context, we also performed a second LUS to evaluate residual pulmonary congestion after clinical improvement. In our cohort, B-lines decreased significantly from 17.26 ± 11.0 to 6.85 ± 6.66, the latter number being very similar to that we have previously reported in stable patients (5.1 ± 6.1), 22 but still significantly higher than that in the episodes considered as non-decompensation. That fact probably reflects that some pulmonary congestion still remains despite the observed clinical improvement.…”

Section: Lung Ultrasound Findingssupporting

confidence: 90%

“…Therefore, it is not surprising that, in this study, episodes without a clinical final diagnosis of HF decompensation showed 3.7 ± 4.5 B-lines on LUS, quite comparable with the sum of B-lines we found in HF stable patients. 22 As expected, episodes classified as having left or global HF decompensation had higher numbers of B-lines, even taking into consideration the fact that pleural effusion, which can also be observed in right HF decompensation, accounted for 10 B-lines.…”

Section: Lung Ultrasound Findingssupporting

confidence: 71%

“…This result suggests that LUS could be useful for clinicians in tailoring HF diuretic therapy during decompensation; in fact, LUS-guided treatment has been reported to be effective in both chronic and acute HF post discharge, 24,25 because LUS examination might be more sensitive in detecting congestion than clinical evaluation in several HF scenarios. 16,21,22,26 Other technologies are arising for early HF decompensation evaluation in outpatients such as impedance measurement, home telemonitoring, and wearable technology and Lung ultrasound in outpatients with heart failure devices that measure pulmonary artery or left atrial pressure wirelessly. Integrating LUS with some of these tools could become a novel approach that have to be investigated.…”

Section: Lung Ultrasound Findingsmentioning

confidence: 99%

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Lung ultrasound in outpatients with heart failure: the wet‐to‐dry HF study

et al. 2021

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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 areas. Diagnosis of no HF decompensation vs. right-sided, left-sided, or global HF decompensation, and patients' management were performed by physicians blinded to LUS1. Outcome was the composite of all-cause death or HF-related hospitalization. Two hundred and thirty-three suspicions of HF decompensation were included in 187 patients (71.4 ± 11.3 years, 66.8% men). Mean B-line (LUS1) was 17.6 ± 11.2 vs. 3.7 ± 4.5 for episodes with and without HF decompensation, respectively (P < 0.001). Global HF decompensation showed the highest number of B-lines (20.6 ± 11), followed by left-sided (19.7 ± 11.6) and right-sided (13.5 ± 9.8). B-lines declined to 6.9 ± 6.7 (LUS2) (P < 0.001 vs. LUS1) after treatment, within a mean time of 24.2 ± 23.7 days [median 13.5 days (interquartile range 6-40)]. B-lines were significantly associated with the composite endpoint at 30 days (hazard ratio [HR] 1.04 [95% confidence interval 1.01-1.07], P = 0.02), but not at 60 (P = 0.22) or 180 days (P = 0.54). In multivariable analysis, B-line number remained as an independent predictor of the composite endpoint at 30 days, [HR 1.04 (1.01-1.07), P = 0.014], with a 4% increase risk per B-line added. B-lines correlated significantly with CA125 (R = 0.30, P = 0.001). Conclusions Lung ultrasound supports the diagnostic work-up of congestion and decongestion in chronic HF outpatients and identifies patients at high risk of short-term events.

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Section: Lung Ultrasound Findingssupporting

confidence: 90%

Section: Lung Ultrasound Findingssupporting

confidence: 71%

Section: Lung Ultrasound Findingsmentioning

confidence: 99%

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Lung ultrasound in outpatients with heart failure: the wet‐to‐dry HF study

et al. 2021

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“…In a prospective cohort study, Dwyer et al reported data from outpatient echocardiography and LUS for 111 hypertensive, 46 HFpEF and 73 HFrEF patients, the prevalence of ≥3 B‐lines was 13.5%, 34.8%, and 45.2%, respectively, again, worse outcome was found in HF patients with ≥3 B‐lines (age‐ and sex‐adjusted hazard ratio 2.62, 95% CI 1.15, 5.96; p = .022) 24 (Tables 3 and 4). Domingo et al reported the impact of the number of LUS detected B‐line and outcome in 577 chronic HF stable ambulatory patients, results showed that the total sum of B‐lines remained as an independent predictive factor of the composite endpoint (hazard ratio 1.04, 95% CI 1.02–1.06, p = .002) and of all‐cause death (hazard ratio 1.04, 95% CI 1.02–1.07, p = .001), independently of whether or not N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) was included in the model ( p = .01 and p = .008, respectively), with a 3%–4% increased risk for each 1‐line addition 26 …”

Section: Incidence and Impact On Outcome Of Pulmonary Congestion In Patients With Chronic Heart Failurementioning

confidence: 99%

Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure

Zhu

Zeng

2021

Clinical Cardiology

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Chronic heart failure is one of the common causes of hospitalization and death. Pulmonary congestion is the common disease feature of patients with chronic heart failure, which could be correctly diagnosed by lung ultrasound. Efficacy of lung ultrasound‐guided pulmonary congestion management for patients with acute heart failure is well documented, however, more evidence is needed to establish the clinical value of pulmonary congestion detection by lung ultrasound examination in patients with chronic heart failure. This review summarized current evidence related to the use and clinical value of pulmonary congestion assessment by lung ultrasound in patients with chronic heart failure, aiming to provide new suggestions on promoting the widespread use of lung ultrasound in patients with chronic heart failure to improve the quality of life and outcome of patients with chronic heart failure.

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“…A recent study including 577 patients showed the importance of B-line count as an independent prognostic factor. Quantifying B-line number in quartiles identifies patients at high risk-in particular, a high number of Blines identified patients with a 2.6× increased risk of death and rehospitalization [50]. Like PC, outpatients who are followed-up with LUS can achieve a relevant improvement of prognostic stratification by a tailored treatment focused on decongestive therapy optimization that is LUS-guided.…”

Section: Relevance Of Lung Ultrasound In Different Settingsmentioning

confidence: 99%

Pulmonary Congestion Assessment in Heart Failure: Traditional and New Tools

et al. 2021

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Congestion related to cardiac pressure and/or volume overload plays a central role in the pathophysiology, presentation, and prognosis of heart failure (HF). Most HF exacerbations are related to a progressive rise in cardiac filling pressures that precipitate pulmonary congestion and symptomatic decompensation. Furthermore, persistent symptoms and signs of congestion at discharge or among outpatients are strong predictors of an adverse outcome. Pulmonary congestion is also one of the most important diagnostic and therapeutic targets in chronic heart failure. The aim of this review is to analyze the importance of clinical, instrumental, and biochemical evaluation of congestion in HF by describing old and new tools. Lung ultrasonography (LUS) is an emerging method to assess pulmonary congestion. Accordingly, we describe the additive prognostic role of chest ultrasound with respect to traditional clinical and X-ray assessment in acute and chronic HF setting.

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Prognostic value of lung ultrasound in chronic stable ambulatory heart failure patients

Cited by 8 publications

References 25 publications

Lung ultrasound in outpatients with heart failure: the wet‐to‐dry HF study

Lung ultrasound in outpatients with heart failure: the wet‐to‐dry HF study

Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure

Pulmonary Congestion Assessment in Heart Failure: Traditional and New Tools

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