Lung ultrasound–guided management to reduce hospitalization in chronic heart failure: a systematic review and meta-analysis

Mhanna, Mohammed; Beran, Azizullah; Nazir, Salik; Sajdeya, Omar; Srour, Omar; Ayesh, Hazem; Eltahawy, Ehab

doi:10.1007/s10741-021-10085-x

Cited by 26 publications

(26 citation statements)

References 18 publications

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“…Our study significantly increases the amount of evidence available for HF-related rehospitalization. In the previous meta-analysis, LUS-guided therapy was associated with a lower rate of urgent care visits (RR, 0.32; 95% CI, 0.18–0.59; p = 0.0002) ( 18 ). Although there is good consistency between previous RCTs and pooled estimates in this meta-analysis, it is good practice to frame the newest evidence in the context of previous evidence ( 38 ).…”

Section: Discussionmentioning

confidence: 97%

“…In a recent systematic review and meta-analysis, a total of three randomized controlled trials (RCTs) involving 493 patients with HF were included. A total of 251 patients were managed with LUS + physical examination (PE)-guided treatment, whereas 242 subjects were managed with PE-guided therapy alone ( 18 ). The mean follow-up period was 5.0 months.…”

Section: Introductionmentioning

confidence: 99%

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Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial.PurposeWe aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF.Materials and methodsWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through systematic searches of MEDLINE, EMBASE, the Cochrane Database, Google Scholar, and SinoMed. The primary outcome was MACEs (a composite of all-cause mortality, HF-related rehospitalization, and symptomatic HF). The required information size was calculated by trial sequential analysis (TSA).ResultsIn total, ten RCTs involving 1,203 patients were included. Overall, after a mean follow-up period of 4.7 months, LUS-guided treatment was associated with a significantly lower risk of MACEs than usual care [relative risk (RR), 0.59; 95% confidence interval (CI), 0.48–0.71]. Moreover, the rate of HF-related rehospitalization (RR, 0.63; 95% CI, 0.40–0.99) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration (standardized mean difference, –2.28; 95% CI, –4.34 to –0.22) were markedly lower in the LUS-guided treatment group. The meta-regression analysis showed a significant correlation between MACEs and the change in B-line count (p < 0.05). The subgroup analysis revealed that the risk of MACEs was markedly lower in patients aged up to 70 years (RR, 0.54; 95% CI, 0.44–0.67), with a lower rate of atrial fibrillation (< 27.2%) (RR, 0.53; 95% CI, 0.43–0.67), and with a lower NT-proBNP concentration (< 3,433 pg/ml) (RR, 0.51; 95% CI, 0.40–0.64). TSA indicated a lower risk of MACEs with LUS-guided treatment than with usual care among patients with HF (p < 0.05).ConclusionLung ultrasound seems to be a safe and effective method to guide HF treatment.Systematic review registration[https://inplasy.com/], identifier [INPLASY202220124].

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

et al. 2022

Front. Cardiovasc. Med.

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“…Three previous randomized clinical trials (RCT) investigating LUS-guided management of HF patients in outpatient settings that included a total of 493 patients were analyzed in a recent meta-analysis showing that this strategy significantly improved urgent visits for worsening HF at three months in one study and six months in the other two; however, it did not significantly decrease hospitalization (RR 0.65; 95% CI 0.34–1.22; p = 0.18) or all-cause mortality rates (RR 1.39; 95% CI 0.68–2.82; p = 0.37). These studies were single-center trials performed in cardiology departments, and patients were significantly younger, with fewer comorbidities and a greater proportion of left ventricular dysfunction than ours [ 30 ]. Moreover, the proportion of patients who reached the primary endpoint in our study was similar to the LUS group in a previous RCT and lower than patients in the SOC groups.…”

Section: Discussionmentioning

confidence: 99%

The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial

Torres‐Macho

González

Arévalo-Lorido

et al. 2022

JCM

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Background: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound is highly sensitive for detecting PC. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF. Methods: A randomized, multicenter, single-blind clinical trial in patients discharged after hospitalization for decompensated HF. Participants were assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus standard of care (SOC). The primary endpoint was the combination of cardiovascular death, readmission, or emergency department or day hospital visit due to worsening HF at 6 months. In September 2020, after an interim analysis, patient recruitment was stopped. Results: A total of 79 patients were randomized (mean age 81.2 +/− 9 years) and 41 patients (51.8%) showed a left ventricular ejection fraction >50%. The primary endpoint occurred in 11 patients (29.7%) in the SOC group and in 11 patients (26.1%) in the LUS group (log-rank = 0.83). Regarding nonserious adverse events, no significant differences were found. Conclusions: LUS-guided diuretic therapy after hospital discharge due to ADHF did not show any benefit in survival or a need for intravenous diuretics compared with SOC.

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“…Therefore, indications for LUS are growing in cardiology, especially in patients with heart failure or dyspnea ( 5 , 6 ). LUS can predict the prognosis of patients with acute and chronic heart failure ( 7 , 8 ), and LUS-guided treatment can reduce the rehospitalization rate of patients with HF ( 9 ). A recent study suggested that LUS added to the Killip classification was more sensitive than physical examination to identify patients with ST-Elevation Myocardial Infarction (STEMI) at risk of in-hospital mortality ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

B-Lines by Lung Ultrasound Can Predict Worsening Heart Failure in Acute Myocardial Infarction During Hospitalization and Short-Term Follow-Up

Zhou

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAcute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. It has been proved to predict prognosis in heart failure; however, whether it can be used as a short-term prognostic marker in AMI and provide incremental value to Killip classification is unknown.MethodsWe performed echocardiography and LUS by the 8-zone method in patients enrolled in Guangdong Provincial People's Hospital undergoing percutaneous coronary intervention for AMI from March to July 2021. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows: normal (B-line numbers <5), mild (B-line numbers ≥5 and <15), moderate (B-line numbers ≥15 and <30), and severe (B-line numbers ≥30). The NT-proBNP analysis was performed on the same day. All patients were followed up for 30 days after discharge. The adverse events were defined as all-cause death, worsening heart failure in hospitalization, or re-hospitalization for heart failure during the follow-up.ResultsSixty three patients were enrolled consecutively and followed up for 30 days. The number of B-lines at admission (median 7[3–15]) was correlated with NT-proBNP (r = 0.37, p = 0.003) and negatively correlated with ejection fraction (r = −0.43; p < 0.001) separately. In the multivariate analysis, B-line number was an independent predictor of short-term outcomes in AMI patients (in-hospital, adjusted OR 1.13 [95% CI: 1.04–1.23], P = 0.006; 30-day follow-up, adjusted OR 1.09 [95% CI: 1.01–1.18], P = 0.020). For in-hospital results, the area under the receiver operating characteristic curves (AUCs) were 0.639 (P = 0.093), 0.837 (P < 0.001), and 0.847 (P < 0.001) for Killip, LUS and their combination, respectively. For the diagnosis of 30-day adverse events, the AUCs were 0.665 for the Killip classification (P = 0.061), 0.728 for LUS (P = 0.010), and 0.778 for their combination (P = 0.002).ConclusionB-lines by lung ultrasound can be an independent predictor of worsening heart failure in AMI during hospitalization and short-term follow-up and provides significant incremental prognostic value to Killip classification.

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Lung ultrasound–guided management to reduce hospitalization in chronic heart failure: a systematic review and meta-analysis

Cited by 26 publications

References 18 publications

Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial

B-Lines by Lung Ultrasound Can Predict Worsening Heart Failure in Acute Myocardial Infarction During Hospitalization and Short-Term Follow-Up

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