Pulmonary congestion by lung ultrasound in decompensated heart failure: associations, in-hospital changes, prognostic value

Abstract

Background. Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF).Objective: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients.Materials and methods. Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively.Results. Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003).Conclusion. During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.

Prognostic significance of Lung ultrasound for Heart Failure Patient Management in Primary Care. A Systematic Review

“…The prognostic significance of the number of B-lines varied across studies. Most studies indicated that a sum of ≥5 B-lines was associated with a higher probability of 12-month all-cause death, and ≥15 B-lines with higher probability of HF readmission [45,[50][51][52]56,61,65]. Others [57] suggested that the presence of 30-40 B-lines at admission was a risk factor for readmission or mortality, and the presence of ≥15 B-lines could indicate just an increased risk of persistent pulmonary congestion.…”

“…However, mortality was associated to significantly lower IVC collapse [65,70,71], and a greater number of lung B-lines; and higher NT-proBNP levels [65,[68][69][70] without differences in the BIA parameters. Among the most individuals with ambulatory follow-up and preserved ejection fraction [66,73], the submaximal exercise increases B-lines number to level of higher probability of 12-month all-cause death or/ and higher probability of HF decompensation [45,[50][51][52]56,61]. Total Bline sum correlated significantly, although moderately, with congestion and several inflammation biomarkers.…”

Recommendations for Lung Ultrasound in Internal Medicine

“…Experts’ comments [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ,…”

Lung Ultrasound: new Opportunities for a Cardiologist

“…В 2004 г. Е. Picano и Jambrik в лаборатории эхокардиографии Института клинической физиологии Национального научно-исследовательского совета Италии перенесли УЗИ легких из отделения интенсивной терапии в отделение кардиологии, описав корреляцию между содержанием внесосудистой жидкости в легких, оцененной с помощью рентгенографии грудной клетки, и количеством B-линий, обнаруженных при УЗИ легких [18]. В последующие годы была предоставлена экспериментальная [9,19], клиническая [20][21][22][23] и методологическая [24] валидация B-линий.…”