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Lung ultrasound in acute heart failure: Prevalence of pulmonary congestion and short- and long-term outcomes
Platz, Elke Campbell, Robert T. Claggett, Brian L. Lewis, Eldrin F. Groarke, John D. Docherty, Kieran F. Lee, Matthew M. Y. Merz, Allison A. Silverman, Montane Swamy, Varsha
Platz, Elke
Campbell, Robert T.
Claggett, Brian L.
Lewis, Eldrin F.
Groarke, John D.
Docherty, Kieran F.
Lee, Matthew M. Y.
Merz, Allison A.
Silverman, Montane
Swamy, Varsha
Abstract
Objectives This study sought to assess the prevalence, changes in, and prognostic importance of B-lines, a pulmonary congestion measure by using a simplified lung ultrasonography (LUS) method in acute heart failure (AHF). Background Pulmonary congestion is an important finding in AHF, but conventional methods for its detection are insensitive. Methods In a 2-site, prospective, observational study, 4-zone LUS was performed early during hospitalization for AHF (LUS1) and at discharge (LUS2). B-lines were quantified off-line, blinded to clinical findings and outcomes, by a core laboratory. Results Among 349 patients (median, 75 years of age; 59% men; mean ejection fraction 39%), the sum of B-lines in 4 zones ranged from 0 to 18 (LUS1). The risk of an adverse in-hospital event increased with rising number of B-lines on LUS1: the odds ratio for each B-line tertile was 1.82 (95% confidence interval [CI]: 1.14 to 2.88; p = 0.011). B-line count decreased from a median of 6 (LUS1) to 4 (LUS2; p < 0.001) over 6 days (median). In 132 patients with LUS2 images, the risk of HF hospitalization or all-cause death was greater in patients with a higher number of B-lines at discharge. This relationship was stronger closer to discharge: unadjusted hazard ratio (HR) at 60 days was 3.30 (95% CI: 1.52 to 7.17; p = 0.002); 2.94 at 90 days (95% CI: 1.46 to 5.93; p = 0.003); and 2.01 at 180 days (95% CI: 1.11 to 3.64; p = 0.021). The association between number of B-lines and short- and long-term outcomes persisted after adjusting for important clinical variables, including N-terminal pro–B-type natriuretic peptide. Conclusions Pulmonary congestion using a simplified 4-zone LUS method was common in patients with AHF and improved with therapy. A higher number of B-lines at baseline and discharge identified patients at increased risk for adverse events.
Keywords
acute heart failure, lung ultrasonography, prognosis, pulmonary congestion
Date
2019
Type
Journal article
Journal
JACC: Heart Failure
Book
Volume
7
Issue
10
Page Range
849-858
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled