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

Abstract

Aims Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in patients admitted for acute HF. Methods and results This is a post-hoc analysis of the LUS-HF trial. LUS was performed by the investigators in eight chest zones with a pocket device. Physical exam was subsequently performed by the treating physicians. Primary outcome was a combined endpoint of rehospitalization, unexpected visit for HF worsening or death at 6month follow-up. Subclinical pulmonary congestion at discharge was defined as the presence of ≥5 B-lines in LUS in absence of rales in the auscultation employing the area under the ROC curve. At discharge, 100 patients (81%) did not show clinical signs of pulmonary congestion. Of these, 41 had ≥5 B-lines. Independent factors related with the presence of subclinical pulmonary congestion were anaemia, higher New York Heart Association (NYHA) class, and N terminal pro brain natriuretic peptide (NT-proBNP). After adjusting by propensity score analysis including age, renal insufficiency, atrial fibrillation, NYHA class, NT-proBNP levels, clinical congestion, and the trial intervention, the presence of subclinical pulmonary congestion at discharge was a risk factor for the occurrence of the primary outcome (hazard ratio 2.63; 95% confidence interval: 1.08-6.41; P = 0.033). Conclusions Up to 40% of patients considered 'dry' according to pulmonary auscultation presents subclinical congestion at hospital discharge that can be detected by LUS and implies a worse prognosis at 6month follow-up. Comorbidities, high values of natriuretic peptides, and higher NYHA class are the factors related with its presence.

Impact of Residual B-lines at Discharge on Outcome of Heart Failure Patients（IMP-OUTCOME)

“…This trial is a prospective single-center observational cohort study. The study design was based on the LUS-HF trial [9]. It was shown that LU-BL was present at discharge in 40% of HF patients.…”

“…Previous study demonstrated that the increased number of LU-detected B lines (LU-BL) was associated with a lower 6-min walk distance and higher echocardiography-derived E / e ' value [8]. It was also shown that presence of PC was associated with worse 6-month outcomes in chronic heart failure patients [9,10]. Various clinical studies have indicated the e cacy of targeting PC on reducing acute decompensation and improving walking capacity in chronic heart failure patients [2,11,12].…”

Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure

“…Numerous trials and epidemiological studies have demonstrated the prevalence of PC in patients with CHF 19,21–24 . LUS‐HF study is a single‐blind clinical trial, 123 patients admitted for HF were included in this trial, 25 the post hoc analysis of the LUS‐HF trial showed that that up to 40% of patients considered “dry” according to pulmonary auscultation presented LUS‐evidenced PC at hospital discharge, and these patients also experienced worse prognosis at 6‐month follow‐up 21 .…”

The Altmetric Attention Score: how science tries to meet social media

“…However, even within a niche field like HF, it is possible to analyse which issues gain more interest and are more requested, thus partially representing the ‘news value’ of a journal. Tables 2–5 report the top 10 articles published in 2019 and 2020 in the European Journal of Heart Failure and ESC Heart Failure , according to their Altmetric Attention Score 5–44 . 2020 was the year of…”