Prognostic value of the ultrasonic determination of the degree of interstitial edema in patients with intermediate ejection fraction of the left ventricle after treating acute decompensation of heart failure

Abstract

Aim To study ultrasonic characteristics of lung tissue in patients with heart failure with left ventricular (LV) mid-range ejection fraction (HFmEF) and predictive value of these characteristics after reversing acute decompensated heart failure (ADHF).Material and methods Ultrasonic characteristics of lung tissue were studied by prospective observation in 71 patients (mean age, 65.2±3.6 years; men, 64.3 %) with HFmEF (LVEF from 40 to 49 %) following ADHF reversal. Semiquantitative evaluation of B-lines was performed by the E. Picano (2016) method at 5+2 days after hospitalization and on discharge from the hospital. The distance between B-lines was 3 mm (В3 lines) and 7 mm (В7 lines). Patients’ catamnesis was studied for determining the predictive value of lung tissue ultrasonic characteristics for two years since the index hospitalization. Statistical analysis was performed using the McNemar’s χ2 test (for evaluation of linked samples and of changes in the presence/absence of B-lines as determined by lung ultrasound examination (USE)) and the Wilcoxon test (for evaluation of quantitative changes). Differences were considered significant at p<0.05.Results B7-lines characteristic of interstitial component of pulmonary parenchymal edema prevailed in patients with HFmEF. В3-lines characteristic of alveolar edema were found in a small amount. In the anterior-superior segment, B7-lines predominated over B3-lines (80 % vs. 20 %, p<0.01) on the right; however, on the lest, significant differences were not observed (64 % vs. 36 %, p>0.05). In the anterior-inferior segment, В7-lines prevailed over В3-lines on the right (75 % vs. 25 %, p<0.05); however, on the left, the difference was not significant (67 % vs. 33 %, p=0.05). In the lateral superior segment on the right, В7-lines predominated over В3-lines (75 % vs. 25 %, p<0.01); in contrast, on the left, there were no differences (67 % vs. 33 %, p>0.05). In lateral-basal segments on both sides, significant differences were present (73 % vs. 27 % on the right, p<0.05; 72 % vs. 28 % on the lest, p<0.05). The results of lung ultrasound were also used for evaluation of the B-line predictive value in patients with ADHF and mid-range EF on discharge from the hospital after reversal of X-ray and clinical symptoms of pulmonary congestion. In the next two years, 35 patients (49.2 % of sample) were rehospitalized with signs of ADHF (39 hospitalizations, 1.1 hospitalizations per patient). The rehospitalized patients were divided into two subgroups, with an increased number of B-lines and small congestion on discharge (6–15 В-lines) and without signs of congestion (<5 В-lines). For patients with a minimal (small) congestion on pulmonary ultrasound but regression of clinical and X-ray congestion, the number of rehospitalizations was 25 vs. 11 in patients with the number of B7-lines <5. In the ROC-analysis, the area under the curve was 0.706, which corresponded to the expert assessment as “good”. The position sensitivity was 78.6 % and the specificity was 79.7 %.Conclusion “Ultrasonic pulmonary edema syndrome” in patients with LV mid-range ejection fraction after reversing ADHF was characterized by predomination of the interstitial component, despite the absence of X-ray congestion, correlated with the blood level of NT-proBNP measured at the same time, and was associated with rehospitalizations.

Prognostic impact of lung ultrasound detected B-lines on hospitalised ischaemic heart failure with mildly reduced ejection fraction patients

“… 7 It was reported that LUS-BL was related to poor outcome in HFpEF and HFrEF patients. 13 14 In line with results obtained from a small patient cohort, which showed LUS-BL was related to readmission during 2-year follow-up among 71 HFmrEF patients, 10 we found that LUS-BL at admission was independently related to poor CV outcome at 90 days after discharge among ischaemic HFmrEF patients, especially in patients with concomitant hypertension. The results hint that more guideline-directed medical therapies, as shown by up-titration of guideline-directed medical therapies for acute HF (STRONG-HF) trial, which demonstrated that intensive treatment strategy of rapid up-titration of guideline-directed medication and close follow-up after an acute HF admission was readily accepted by patients because it reduced symptoms, improved quality of life and reduced the risk of 180-day all-cause death or HF readmission compared with usual care, 15 might be also helpful to improve the CV outcome of ischaemic HFmrEF patients with LUS-BL>11, especially those with concomitant hypertension.…”

“…Results showed that the presence of LUS-BL was associated with rehospitalisation up to 2 years after discharge. 10 In this subgroup analysis, we evaluated the prognostic impact of LUS-BL on CV outcome at 90 days and 1-year after discharge in enrolled HFmrEF patients with LUS results at admission. 3 …”

Update on the Value of Lung Ultrasound Examination in Acute Decompensated Heart Failure Patients with Various Left Ventricular Ejection Fraction

“…The results of previous clinical studies on PC status in HFm-rEF patients are sometimes difficult to interpret, since the enrolled "HFmrEF" patients in previous studies are in fact "HFpEF" or "HFrEF" patients per current definition. Skorodumova et al [48] explored PC status in ADHF patients with HFmrEF through LUS. They found that after the remission of ADHF, pulmonary interstitial congestion was still dominant (the distance between B-lines was 7 mm), there was a small amount of pulmonary edema (the distance between B-lines was 3 mm), and the number of B-lines was related to the simultaneous detection of N-terminal pro-Btype natriuretic peptide (NT-proBNP) level and readmission.…”

“…Skorodumova et al . [ 48 ] explored PC status in ADHF patients with HFmrEF through LUS. They found that after the remission of ADHF, pulmonary interstitial congestion was still dominant (the distance between B-lines was 7 mm), there was a small amount of pulmonary edema (the distance between B-lines was 3 mm), and the number of B-lines was related to the simultaneous detection of N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and readmission.…”