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Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure

European journal of heart failure, 2015-11, Vol.17 (11), p.1172-1181 [Peer Reviewed Journal]

2015 The Authors © 2015 European Society of Cardiology ;2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology. ;Distributed under a Creative Commons Attribution 4.0 International License ;ISSN: 1388-9842 ;EISSN: 1879-0844 ;DOI: 10.1002/ejhf.344 ;PMID: 26417699

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Title:
Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure
Author: Coiro, Stefano ; Rossignol, Patrick ; Ambrosio, Giuseppe ; Carluccio, Erberto ; Alunni, Gianfranco ; Murrone, Adriano ; Tritto, Isabella ; Zannad, Faiez ; Girerd, Nicolas
Subjects: Aged ; Aged, 80 and over ; B-lines ; Cardiology and cardiovascular system ; Chest ultrasound ; Continuity of Patient Care ; Disease Management ; Echocardiography ; Echocardiography - methods ; Female ; Follow-Up Studies ; France ; France - epidemiology ; Heart Failure ; Heart Failure - complications ; Heart Failure - diagnosis ; Heart Failure - epidemiology ; Heart Failure - physiopathology ; Heart Failure - therapy ; Human health and pathology ; Humans ; Life Sciences ; Lung ; Lung - diagnostic imaging ; Lung ultrasound ; Male ; Middle Aged ; Monitoring, Physiologic ; Monitoring, Physiologic - methods ; Natriuretic Peptide, Brain ; Natriuretic Peptide, Brain - blood ; Patient Discharge ; Patient Discharge - statistics & numerical data ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Pulmonary congestion ; Pulmonary Edema ; Pulmonary Edema - blood ; Pulmonary Edema - diagnosis ; Pulmonary Edema - etiology ; Pulmonary Edema - mortality ; Pulmonary Edema - physiopathology ; Retrospective Studies
Is Part Of: European journal of heart failure, 2015-11, Vol.17 (11), p.1172-1181
Description: Aims Residual pulmonary congestion at discharge is associated with poor prognosis in heart failure (HF), but its quantification through physical examination is challenging. Ultrasound imaging of lung comets (B‐lines) could improve congestion evaluation. The aim of this study was to assess the short‐term prognostic value of B‐lines after discharge from HF hospitalisation compared with other indices of haemodynamic congestion (BNP, E/e', and inferior vena cava diameter) or clinical status (NYHA class). Methods and results Sixty consecutive HF inpatients underwent clinical examination, echocardiography, and lung ultrasound at discharge, independently of, and in addition to routine management by the attending physicians. The median B‐line count was 8.5 (5–34). Three‐month event‐free survival for the primary endpoint (all‐cause death or HF hospitalisation) was 27 ± 10% in patients with ≥30 B‐lines and 88 ± 5% in those with <30 B‐lines (P < 0.0001). In a multivariable model, ≥30 B‐lines significantly predicted the combined endpoint (hazard ratio 5.66, 95% confidence interval 1.74–18.39, P = 0.04), along with NYHA ≥III and inferior vena cava diameter, while other indirect measures of congestion (BNP and E/e' ≥15) were not retained in the model; furthermore ≥30 B‐lines independently also predicted the secondary outcomes (HF hospitalisation and death). Importantly, B‐line addition to NYHA class and BNP was associated with improved risk classification (integrated discrimination improvement 15%, P = 0.02; continuous net reclassification improvement 65%, P = 0.03). Conclusion Residual pulmonary congestion at discharge, as assessed by a B‐line count ≥30, is a strong predictor of outcome. Lung ultrasonography may represent a useful tool to identify and monitor congestion and optimize therapy during and/or after hospitalisation for HF, which should be further validated in multicentre studies.
Publisher: Oxford, UK: John Wiley & Sons, Ltd
Language: English
Identifier: ISSN: 1388-9842
EISSN: 1879-0844
DOI: 10.1002/ejhf.344
PMID: 26417699
Source: MEDLINE
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Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure

2015 The Authors © 2015 European Society of Cardiology ;2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology. ;Distributed under a Creative Commons Attribution 4.0 International License ;ISSN: 1388-9842 ;EISSN: 1879-0844 ;DOI: 10.1002/ejhf.344 ;PMID: 26417699

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