One year prognostic value of B‐lines in dyspnoeic patients

Bidaut, Auriane; Hubert, Arnaud; Charton, Marion; Paven, Elise; Leclercq, Christophe; Galli, Elena; Donal, Erwan

doi:10.1002/ehf2.12739

Cited by 6 publications

(9 citation statements)

References 32 publications

(62 reference statements)

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“…The feasibility of the LASr measurements was 92%. During the 26 [22,32] months follow up we detected 11 events: 4 patients were treated at an emergency department for an acute HF episode, 2 patients were admitted to the cardiology ward due to severe HF symptoms, 3 patients needed ambulatory intensification of loop diuretic treatment due to worsening of HF symptoms and 2 patients died (1 unknown cause, 1 patient during HF event). Having >15 B-lines significantly increased the risk of the endpoint events, and during the multivariate analysis, proved it to be an independent predictor of endpoint events (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…B-lines also have an exceptional prognostic value, shown in patients with HF (19)(20)(21)(29)(30)(31). After a 1-year follow-up in dyspneic patients, an increased number of B-lines was associated with a higher hospitalization rate with a best cut-off at 6 B-lines (8 sector LUS) (32). Measurement of PC at discharge provides prognostic information for patients with either HFpEF (33,34) or HFrEF (34).…”

Section: Discussionmentioning

confidence: 99%

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The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

Morvai-Illes

Polestyuk-Németh

Szabó

et al. 2021

Front. Cardiovasc. Med.

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Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed.Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting.Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death.Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001).Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

Morvai-Illes

Polestyuk-Németh

Szabó

et al. 2021

Front. Cardiovasc. Med.

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“…Previous studies have demonstrated that residual pulmonary congestion by LUS predicts adverse events in chronic HF. 21 However, a standardized definition for residual pulmonary congestion is not established yet. Previous authors have reported several cut-off numbers of B-lines with prognostic significance according to the LUS protocol performed and the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…Previous authors have reported several cut-off numbers of B-lines with prognostic significance according to the LUS protocol performed and the clinical setting. 21 , 22 In many cases, they employed the area under the ROC curve to identify the best number to predict the adverse outcomes by applying the Youden criteria. In our study, as residual pulmonary congestion develops when LAP increases beyond a critical threshold, we employed the area under the ROC curve to identify the best number to predict above a pivot point of the increasing number of B-lines.…”

Section: Discussionmentioning

confidence: 99%

Association between B-lines on lung ultrasound, invasive haemodynamics, and prognosis in acute heart failure patients

Imanishi

Maeda

Ujiro

et al. 2022

European Heart Journal. Acute Cardiovascular Care

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Aims Increased left atrial pressure leads to pulmonary congestion. Although the B-lines in lung ultrasound (LUS) are useful in detecting pulmonary congestion, data regarding the association between B-lines and invasive hemodynamics are inconsistent. This study aimed to explore the correlation of the B-line count by LUS with pulmonary capillary wedge pressure (PCWP) stratified for preserved and reduced ejection fraction (EF) in acute heart failure patients. Methods and Results We performed a prospective observational study on 116 hospitalized patients with acute heart failure (mean age, 75.2 ± 10.3 years), who underwent right heart catheterization before discharge. LUS was performed in eight zones within 4 h of right heart catheterization and compared with PCWP separately in each EF group. Cardiac events were recorded 1 year after discharge. PCWP revealed a clear pivot point at which the B-lines began to increase in the overall cohort and each EF. Specific thresholds of the increase in B-lines were identified at 19 and 25 mmHg for preserved and reduced EF, respectively. Residual congestion at discharge was defined as the presence of ≥6 B-lines. Patients with residual congestion had a higher risk for cardiac events than those without residual congestion (hazard ratio, 12.6; 95% CI, 4.71–33.7; log-rank, P < 0.0001). Conclusions A clear pivot point was associated with increased B-lines count in PCWP at 19 and 25 mmHg for preserved and reduced EF, respectively. Moreover, the increased B-line count above the defined cutoff used to quantify residual congestion was associated with significantly worse outcomes.

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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 ).…”

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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One year prognostic value of B‐lines in dyspnoeic patients

Cited by 6 publications

References 32 publications

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

Association between B-lines on lung ultrasound, invasive haemodynamics, and prognosis in acute heart failure patients

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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