Lung Ultrasound for Heart Failure Diagnosis in Primary Care

Conangla, Laura; Domingo, Mar; Lupón, Josep; Wilke, A.; Juncà, Gladys; Tejedor, Xavier; Volpicelli, Giovanni; Evangelista, Lidia; Pera, Guillem; Toran, Pere; Mas, Ariadna; Cediel, Germán; Verdú, José María; Bayés‐Genís, Antoni

doi:10.1016/j.cardfail.2020.04.019

Cited by 17 publications

(20 citation statements)

References 36 publications

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“…20 Although all LA can be affected by pulmonary congestion, the lower zones are classically the first to exhibit extravascular fluid in all profiles of patients with HF. 21 As expected, data from our study also show that the highest number of B-lines is found in lower lateral areas (LA4 and LA8).…”

Section: Lung Ultrasound Findingssupporting

confidence: 88%

“…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: 88%

Section: Lung Ultrasound Findingsmentioning

confidence: 99%

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

et al. 2021

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“…The present study is a biomarker subanalysis of a prospective cohort of ambulatory patients >50 years old, referred by their primary care physician to NT-proBNP test for suspected new-onset non-acute HF (July 2015 to January 2018) (3). We excluded patients with established HF diagnosis, pulmonary fibrosis, or radiological pachypleuritis.…”

Section: Study Design and Patientsmentioning

confidence: 99%

Lung ultrasound and biomarkers in primary care: Partners for a better management of patients with heart failure?

et al. 2020

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Introduction: The association of pulmonary congestion assessed by lung ultrasound (LUS) and biomarkers—other than N-terminal pro-brain natriuretic peptide (NT-proBNP)—is uncertain. Methods: We investigated the relationship between total B-line count by LUS and several biomarkers in outpatients with suspicion of heart failure (HF). Primary care patients with suspected new-onset nonacute HF were evaluated both with a 12-scan LUS protocol (8 anterolateral areas plus 4 lower posterior thoracic areas) and 11 inflammatory and cardiovascular biomarkers. A cardiologist blinded to LUS and biomarkers except NT-proBNP confirmed HF diagnosis. After log-transformation of biomarkers’ concentrations, unadjusted and adjusted correlations were performed. Results: A total of 170 patients were included (age 76 ± 10 years, 67.6% women). HF diagnosis was confirmed in 38 (22.4%) patients. After adjustment by age, sex, body mass index, and renal function, total B-line sum significantly correlated with NT-proBNP (R = 0.29, p < 0.001), growth/differentiation factor-15 (GDF-15; R = 0.23, p = 0.003), high-sensitive Troponin T (hsTnT; R = 0.36, p < 0.001), soluble interleukin-1 receptor-like 1 (sST2; R = 0.29, p < 0.001), cancer antigen 125 (CA-125; R = 0.17, p = 0.03), high-sensitivity C-reactive protein (hsCRP; R = 0.20, p = 0.009), and interleukin (IL)-6 (R = 0.23, p = 0.003). In contrast, IL-33 (R = −0.01, p = 0.93), IL-1β (R = −0.10, p = 0.20), soluble neprilysin (sNEP; R = 0.09, p = 0.24), tumor necrosis factor-alpha (TNF-α; R = 0.07, p = 0.39), and TNF-α receptor superfamily member 1A (TNFRSF1A; R = 0.14, p = 0.07) did not. Conclusions: Total B-line sum correlated significantly, although moderately, with congestion and several inflammation biomarkers. Unexpectedly, the highest correlation found was with hsTnT.

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“…For this reason, LUS can be an additive, easy, and rapid method for ruling-in patients with a new diagnosis of HF. A recent study evaluating LUS in primary care showed that the evaluation of B-lines in anterior, lateral, and posterior areas demonstrated a positive predictive value (92%) to accurately rule-in HF patients [49]. Associating this value with the negative predictive value of NPs can significantly reduce the diagnostic delay that may lead to treatment delay.…”

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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Lung Ultrasound for Heart Failure Diagnosis in Primary Care

Cited by 17 publications

References 36 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

Lung ultrasound and biomarkers in primary care: Partners for a better management of patients with heart failure?

Pulmonary Congestion Assessment in Heart Failure: Traditional and New Tools

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