Lung ultrasound‐guided treatment in ambulatory patients with heart failure: a randomized controlled clinical trial (LUS‐HF study)

Abstract

AimsLung ultrasound (LUS) is a useful tool with which to assess subclinical pulmonary congestion and to stratify the prognosis of patients with heart failure (HF). The aim of this study was to evaluate whether an LUS‐guided follow‐up protocol improves the outcomes of patients with HF.Methods and resultsIn this single‐blind clinical trial, 123 patients admitted for HF were randomized to either a standard follow‐up (n = 62, control group) or a LUS‐guided follow‐up (n = 61, LUS group). The primary endpoint was a composite of urgent visit, hospitalization for worsening HF and death during follow‐up. Visits were scheduled at 14, 30, 90 and 180 days after discharge. Treating physicians were encouraged to modify diuretic therapy in accordance with the number of B‐lines recorded by LUS. The mean ± standard deviation (SD) age of the patients was 69 ± 12 years and 72% were male. The mean ± SD left ventricular ejection fraction was 39 ± 14%. The hazard ratio for the primary outcome in the LUS group was 0.518 [95% confidence interval (CI) 0.268–0.998; P = 0.049], mainly resulting from a decrease in the number of urgent visits for worsening HF. The number of patients needed to treat to avoid an event was 5 (95% CI 3–62). Other secondary endpoints such as N‐terminal pro‐B‐type natriuretic peptide reduction were not achieved. The safety parameters were similar in the two groups. Patients in the LUS group received more loop diuretics [51 (91%) vs. 42 (75%); P = 0.02] and showed an improvement in the distance achieved in the 6‐min walking test [60 m (interquartile range: 29–125 m) vs. 37 m (interquartile range: 5–70 m); P = 0.023].ConclusionsTailored LUS‐guided diuretic treatment of pulmonary congestion in this proof‐of‐concept study reduced the number of decompensations and improved walking capacity in patients with HF. LUS is a non‐invasive, safe and easy‐to‐use technique with potential clinical applicability to guide pulmonary congestion treatment in patients with HF.

Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure

“…This is a post-hoc analysis of the LUS-HF trial. 11 Briefly, this was a single-centre, single-blind, randomized clinical trial evaluating whether a LUS-guided follow-up protocol improves the outcomes in patients with HF. Patients were required to be aged ≥18 years and to have been hospitalized for ADHF defined by shortness of breath, pulmonary congestion on X-ray, and high N terminal pro brain natriuretic peptide (NT-proBNP) values in the first 24 h of admission (cutoff values: 450 ng/L in patients aged <50 years; >900 ng/L in patients aged 50-75 years; >1800 ng/L in patients aged >75 years).…”

Iatrogenic Decompensated Heart Failure

“…The presence of ≥ 15 B-lines correlates with NT-proBNP > 1000 pg/ml and E/e′ ratio > 15 [45]. This may even lead to improved patient outcomes as demonstrated in a small randomized trial, LUS-HF, which found that recently discharged HF patients who were assessed using LUS during follow-up were associated with a significantly reduced rate of HF re-admissions [46]. Clinicians should thus integrate these newer technologies with physical examination for a more accurate judgement of fluid status.…”

Lung ultrasound in optimizing management of patients with heart failure: current status and future prospects

“…Три стадии легочного застоя при хронической сердечной недостаточности "Сухое" легкое "Мокрое" при нагрузке легкое "Мокрое" в покое легкое Легкое в покое "сухое" "сухое" "мокрое" Легкое при нагрузке "сухое" "мокрое" очень "мокрое" И, наконец, наиболее значимой на сегодняшний день работой, демонстрирующей перспективность использования стратегии оптимизации диуретической терапии пациентов с ХСН под контролем УЗИ легких, является рандомизированное исследование LUS-HF [31,32]. В исследование были включены 123 пациента, поступившие в стационар с декомпенсацией ХСН.…”