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Aims
In ambulatory patients with chronic heart failure (HF), congestion and decongestion assessment may be challenging. The aim of this study is to assess the value of lung ultrasound (LUS) in outpatients with HF in characterizing decompensation and recompensation, and in outcomes prediction.
Methods and results
Heart failure outpatients attended...
Context in source publication
Context 1
... LA sites, the number of B-lines was significantly higher in all LA in episodes with decompensated HF ( Table 3). Lower areas, especially lateral zones (LA4 and LA8), were those with the highest number of B-lines (P < 0.001 for both LA4 and LA8 vs. all the other LA; P = 0.61 between LA4 and LA8). ...Similar publications
Heart failure is a clinical syndrome caused by ventricular insufficiency, which results in decreased activity tolerance and repeated hospitalization, seriously affecting quality of life, and it is the main cause of death in elderly people. In recent years, great progress has been made in the treatment of heart failure, but the prevalence, mortality...
Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality...
Aims:
Data on the clinical course of hypertrophic cardiomyopathy (HCM) are mainly derived from tertiary HCM centre studies, and knowledge of clinical outcomes of patients leaving specialty care and returning to local physicians is limited due to gaps between clinical encounters or complete loss of follow-up. This survey aims to describe the clinic...
Heart failure (HF) is a global public health burden, characterized by frequent emergency department (ED) visits and hospitalizations. Identifying successful strategies to avoid admissions is crucial for the management of acutely decompensated HF, let alone resource utilization. The primary challenge for ED management of patients with acute heart fa...
Acute decompensated heart failure (ADHF) is one of the most common causes of hospital admission for cardiovascular diseases. ADHF often affects the elderly population, is associated with high morbidity, admission rate and mortality. Pulmonary congestion (PC) is the most common cause of hospitalization among ADHF patients. Previous studies have show...
Citations
... The prognostic significance of the number of B-lines varied across studies. Most studies indicated the presence of ≥5 B-lines was found to be associated with a higher probability of 12-month all-cause death, while the presence of ≥15 B-lines was associated with a higher probability of HF readmission [44,[48][49][50][51][52][53][54]. Others [54] suggested that the accumulation of 30-40 B-lines upon admission was identified as a risk factor for readmission or mortality, and the presence of ≥15 B-lines could just indicate an increased risk of persistent pulmonary congestion. ...
... Others [54] suggested that the accumulation of 30-40 B-lines upon admission was identified as a risk factor for readmission or mortality, and the presence of ≥15 B-lines could just indicate an increased risk of persistent pulmonary congestion. Each additional B-line was associated with a 1.82 odds ratio for adverse outcomes [47], or a 3-4% increased risk for each additional B-line, as per reference [50]. (3) LUS-Guided Treatment: LUS-guided treatment was linked to a 45% reduction in the risk of hospitalization and a decrease in urgent visits [45,46,[55][56][57] with follow-up after three months, six months, up to one year. ...
... Additionally, treatment guided by lung ultrasound (LUS) was linked to a reduced risk of Major Adverse Cardiac Events (MACEs) [58,59], and a significantly greater reduction in the number of B-lines during the initial 48 h, but it did not reduce heart failure readmission [57,60,61]. (4) The results of LUS remained independent of NT-proBNP levels [32,43,50,62]. It seems there is not any statistically significant association between median NT-proBNP levels among patients with a positive LUS for congestion and basal median NT-proBNP levels in patients with LUS without signs of congestion. ...
Background: Heart failure (HF) affects around 60 million individuals worldwide. The primary aim of this study was to evaluate the efficacy of lung ultrasound (LUS) in managing HF with the goal of reducing hospital readmission rates. Methods: A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, covering clinical trials, meta-analyses, systematic reviews, and original articles published between 1 January 2019 and 31 December 2023, focusing on LUS for HF assessment in out-patient settings. There is a potential for bias as the effectiveness of interventions may vary depending on the individuals administering them. Results: The PRISMA method synthesized the findings. Out of 873 articles identified, 33 were selected: 19 articles focused on prognostic assessment of HF, 11 centred on multimodal diagnostic assessments, and two addressed therapeutic guidance for HF diagnosis. LUS demonstrates advantages in detecting subclinical congestion, which holds prognostic significance for readmission and mortality during out-patient follow-up post-hospital-discharge, especially in complex scenarios, but there is a lack of standardization. Conclusions: there are considerable uncertainties in their interpretation and monitoring changes. The need for an updated international consensus on the use of LUS seems obvious.
... The absence or low number of B-lines identified a subgroup with an extremely low risk of rehospitalization for HF decompensation [27]. Other researchers showed that the number of B-lines was only associated with the incidence of a composite endpoint at short-term follow-up, while it did not affect the outcomes at 60-day and 180-day follow-up [32]. In contrast, Palazzuoli A. et al. obtained different results; they observed that the ∆ (difference between the number of B-lines at admission and hospital discharge) of B-lines was associated with the incidence of the composite endpoint of death and rehospitalization at the 6-month follow-up [25]. ...
... In our study, patients who required prolonged hospitalization had >20 B-lines on admission. In previous studies, it has been observed that patients who were dehydrated under LUS guidance had a faster clinical improvement [39], although according to other research, quite a long period (median 13.5 days) is needed to reduce B-lines on lung ultrasound [32]. In addition, it should be noted that our patients did not receive either flosine or sacubitril/valsartan for heart failure therapy (the inclusion period of the study was 2018-2019). ...
Background: In daily practice, there are problems with adequately diagnosing the cause of dyspnea in patients with heart failure with preserved and mildly reduced ejection fractions (HFpEF and HFmrEF). This study aimed to assess the usefulness of lung ultrasound in diagnosing HFpEF and HFmrEF and determine its correlation with IGFBP7 (insulin-like growth factor binding protein 7), NTproBNP (N-terminal pro–B-type natriuretic peptide), and echocardiographic markers. Methods: The research was conducted on 143 patients hospitalized between 2018 and 2020, admitted due to dyspnea, and diagnosed with HFpEF and HFmrEF. Venous blood was collected from all participants to obtain basic biochemical parameters, NTproBNP, and IGFBP7. Moreover, all participants underwent echocardiography and transthoracic lung ultrasound. Two years after hospitalization a follow-up telephone visit was performed. Results: The number of B-lines in the LUS ≥ 16 was determined with a sensitivity of—73% and specificity of—62%, indicating exacerbation of heart failure symptoms on admission. The number of B-lines ≥ 14 on admission was determined as a cut-off point, indicating an increased risk of death during the 2-year follow-up period. The factors that significantly impacted mortality in the study patient population were age and the difference between the number of B-lines on ultrasound at admission and at hospital discharge. IGFBP7 levels had no significant effect on the duration of hospitalization, risk of rehospitalization, or mortality during follow-up. Conclusions: Lung ultrasonography provides additional diagnostic value in patients with HFpEF or HFmrEF and exacerbation of heart failure symptoms. The number of B-lines ≥ 14 may indicate an increased risk of death.
... 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. ...
... 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. Each additional B-line was associated with a 1.82 odds ratio for adverse outcomes [44] with a 3% to 4% increased risk for each 1-line addition [50]. ...
... Nonetheless, while LUS improved fluid status with a significantly greater reduction in the number of B-lines during the first 48 hours, it did not reduce heart failure readmission [53,55,62]. 6 4/ The results of LUS remained independent of NT-proBNP levels [32,[48][49][50]. It seems there is any statistically significant association between median NT-proBNP levels among patients with a positive LUS for congestion and basal median NT-proBNP levels in patients with LUS without signs of congestion. ...
Heart failure (HF) affects about 60 million people worldwide, making it one of the chronic conditions with the greatest health and economic impact. The primary objective was to assess the efficacy of lung ultrasound (LUS) in the management of HF in order to intervene early and reduce the rate of hospital readmissions. A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, including clinical trials, meta-analysis, systematic reviews, and original articles from 2019/1/1-2023/12/31, about LUS for the assessment of HF, on an outpatient basis, for HF diagnosis or/and decompensation. There may be risk of bias because the effects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 873 articles were identified of which 33 articles were selected: [n=19] focused on prognostic assessment of HF, [n=11] centred on multimodal diagnostic assessments, and [n=2] addressing therapeutic guidance for HF diagnosis. LUS exhibits advantages in the detection of sub-clinical congestion linked to prognostic significance in re-admission and mortality during out-patient follow-up, after hospital discharge, and in complex scenarios as the patients' homes or institutional long-term care facilities. However, there are considerable uncertainties in their interpretation and monitoring changes due to its lack of standardization. The need for an updated international consensus on the use of LUS seems obvious.
... Kết quả này phù hợp với nghiên cứu của Volpicelli, trong nghiên cứu này, tỷ lệ dương tính của các vùng bên dưới mỗi bên là cao nhất (93,8% và 93,8%) và tỷ lệ dương tính của các vùng trước trên mỗi bên là thấp nhất (67,2% và 65,6%) [7]. Nghiên cứu của Domingo ở các BN suy tim cũng cho thấy vùng 4 và vùng 8 là các vùng có nhiều B-line nhất [8]. ...
Mục tiêu: Khảo sát tỷ lệ và đặc điểm ứ huyết phổi bằng siêu âm phổi ở bệnh nhân suy tim. Đối tượng và phương pháp: Nghiên cứu tiến cứu, mô tả, cắt ngang trên 60 bệnh nhân được chẩn đoán suy tim điều trị tại Trung tâm Tim mạch-Bệnh viện Quân y 103 từ tháng 1/2022- 8/2022. Các bệnh nhân được khám lâm sàng, làm các thăm dò cận lâm sàng và siêu âm phổi đánh giá tình trạng ứ huyết phổi thông qua xác định tràn dịch màng phổi và dấu hiệu B-line. Kết quả: Tỷ lệ ứ huyết phổi là 76,67%, trong đó: Tràn dịch màng phổi đơn thuần chiếm 11,67%, dấu hiệu B-line đơn thuần chiếm 28,33%, ứ huyết phổi gồm cả tràn dịch màng phổi và dấu hiệu B-line chiếm 36,67%. Tỷ lệ bệnh nhân có tràn dịch màng phổi là 48,33%, trong đó tràn dịch màng phổi 2 bên chiếm 33,33%, tràn dịch màng phổi = bên phải đơn độc chiếm 11,67%, tràn dịch màng phổi bên trái đơn độc chiếm 3,33%. Điểm B-line trung bình là 4,65 ± 2,19. B-line ở các vùng bên nhiều hơn các vùng trước, vùng bên dưới ở mỗi bên (vùng 4 và vùng 8) là vùng có nhiều B-line nhất. Điểm B-line có tương quan thuận mức độ vừa với độ suy tim NYHA (r = 0,323; p<0,05), với nồng độ NT-proBNP (0,454; p<0,05). Kết luận: Đa số bệnh nhân suy tim có ứ huyết phổi (76,67%) với biểu hiện tràn dịch màng phổi và/hoặc dấu hiệu B-line trên siêu âm. Đặc điểm ứ huyết phổi ở bên phải nhiều hơn bên trái. Ứ huyết phổi có liên quan với mức độ suy tim theo NYHA và nồng độ NT-proBNP huyết tương.
... Pulmonary congestion (PC) is one of the major characteristics of HF [6][7][8]. The importance of PC in the disease course of HF has been confirmed by numerous clinical trials, and the presence of PC is shown to be associated with a significantly increased risk of mortality and rehospitalization in HF patients [6,9]. Multiple studies have demonstrated the usefulness of assessment of pulmonary congestion from a prognostic point of view. ...
Introduction:
Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated.
Objectives:
This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve.
Methods:
This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022.
Results:
A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139-0.926; p = 0.034).
Conclusions:
The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.
... LUS is already widely used for diagnosis and prognosis in different HF scenarios. [72][73][74] Furthermore, the number and location of B-lines seem to be dynamic and change rapidly after decongestive therapy, making them an attractive marker for monitoring lung decongestion. ...
Congestion plays a major role in the pathogenesis, presentation, and prognosis of heart failure and is an important therapeutic target. However, its severity and organ and compartment distribution vary widely among patients, illustrating the complexity of this phenomenon. Although clinical symptoms and signs are useful to assess congestion and manage volume status in individual patients, they have limited sensitivity and do not allow identification of congestion phenotype. This leads to diagnostic uncertainty and hampers therapeutic decision-making. The present article provides an updated overview of circulating biomarkers, imaging modalities (ie, cardiac and extracardiac ultrasound), and invasive techniques that might help clinicians to identify different congestion profiles and guide the management strategy in this diverse population of high-risk patients with heart failure.
... Over the course of the last decade, accumulating evidence derived from ambulatory settings has suggested that LUS, in addition to its potent diagnostic value [25][26][27], also represents a key prognostic tool in both HF with reduced (HFrEF) and preserved ejection fraction (HFpEF) [25,[27][28][29]. Furthermore, LUS-guided therapy, as compared with standard care, has been shown to reduce the short-and mid-term risk of HF hospitalisations [30,31]. ...
... Over the course of the last decade, accumulating evidence derived from ambulatory settings has suggested that LUS, in addition to its potent diagnostic value [25][26][27], also represents a key prognostic tool in both HF with reduced (HFrEF) and preserved ejection fraction (HFpEF) [25,[27][28][29]. Furthermore, LUS-guided therapy, as compared with standard care, has been shown to reduce the short-and mid-term risk of HF hospitalisations [30,31]. ...
... Pulmonary congestion assessed by LUS is associated with worse prognosis in ambulatory patients [25,[27][28][29]51,62,85,91] (see Table 2 for more details). Platz et al. [25] first demonstrated the prognostic value of B-lines (assessed with the 28-zone protocol) in a cohort of 195 NYHA class II-IV HF outpatients. ...
Pulmonary congestion is a critical finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS) through B-line quantification, the latter of which can be easily measured by all commercially-available probes/ultrasound equipment. As such, LUS represents a useful tool for the assessment of patients with both acute and chronic HF. Several imaging protocols have been described in the literature according to different clinical settings. While most studies have been performed with either the 8 or 28 chest zone protocol, the 28-zone protocol is more time-consuming while the 8-zone protocol offers the best trade-off with no sizeable loss of information. In the acute setting, LUS has excellent value in diagnosing acute HF, which is superior to physical examination and chest X-ray, particularly in instances of diagnostic uncertainty. In addition to its diagnostic value, accumulating evidence over the last decade (mainly derived from ambulatory settings or at discharge from an acute HF hospitalisation) suggests that LUS can also represent a useful prognostic tool for predicting adverse outcome in both HF with reduced (HFrEF) and preserved ejection fraction (HFpEF). It also allows real-time monitoring of pulmonary decongestion during treatment of acute HF. Additionally, LUS-guided therapy, when compared with usual care, has been shown to reduce the risk of HF hospitalisations at short- and mid-term follow-up. In addition, studies have shown good correlation between B-lines during exercise stress echocardiography and invasive, bio-humoral and echocardiographic indices of haemodynamic congestion; B-lines during exercise are also associated with worse prognosis in both HFrEF and HFpEF. Altogether, LUS represents a reliable and useful tool in the assessment of pulmonary congestion and risk stratification of HF patients throughout their entire journey (i.e., emergency department/acute settings, in-hospital management, discharge from acute HF hospitalisation, monitoring in the outpatient setting), with considerable diagnostic and prognostic implications.
... Pulmonary congestion (PC) is one of the major characteristics of HF. 3,4 The importance of PC in the disease course of HF has been confirmed by numerous clinical trials, and the presence of PC is shown to be associated with a significantly increased risk of mortality and rehospitalization in HF patients. [5][6][7] Lung ultrasound (LUS) acts as a semiquantitative, effective, ready-made method to estimate PC. 8 Previous study demonstrated that the increased number of LUS-detected B-lines (LUS-BL) was associated with a lower 6 min walk distance and higher echocardiography-derived E/e' value. 9 It was also shown that presence of PC was associated with worse 6 month outcomes in chronic HF patients. ...
Aims:
Pulmonary congestion (PC) expressed by residual lung ultrasound B-lines (LUS-BL) could exist in some discharged heart failure (HF) patients, which is a known determinant of poor outcomes. Detection efficacy for PC is suboptimal with widely used imaging modalities, like X-ray or echocardiography, while lung ultrasound (LUS) can sufficiently detect PC by visualizing LUS-BL. In this trial, we sought to evaluate the impact LUS-BL-guided intensive HF management post-discharge on outcome of HF patients discharged with residual LUS-BL up to 1 year after discharge. IMP-OUTCOME is a prospective, single-centre, single-blinded, randomized cohort study, which is designed to investigate if LUS-BL-guided intensive HF management post-discharge in patients with residual LUS-BL could improve the clinical outcome up to 1 year after discharge or not.
Methods and results:
After receiving the standardized treatment of HF according to current guidelines, 318 patients with ≥3 LUS-BL assessed by LUS within 48 h before discharge will be randomly divided into the conventional HF management group and the LUS-BL-guided intensive HF management group at 1:1 ratio. Patient-related basic clinical data including sex, age, blood chemistry, imaging examination, and drug utilization will be obtained and analysed. LUS-BL will be assessed at 2 month interval post-discharge in both groups, but LUS-BL results will be enveloped in the conventional HF management group, and diuretics will be adjusted based on symptom and physical examination results with or without knowing the LUS-BL results. Echocardiography examination will be performed for all patients at 12 month post-discharge. The primary endpoint is consisted of the composite of readmission for worsening HF and all-cause death during follow up as indicated. The secondary endpoints consisted of the change in the New York Heart Association classification, Duke Activity Status Index, N terminal pro brain natriuretic peptide value, malignant arrhythmia event and 6 min walk distance at each designed follow up, echocardiography-derived left ventricular ejection fraction, and number of LUS-BL at 12 month post-discharge. Safety profile will be recorded and managed accordingly for all patients.
Conclusions:
This trial will explore the impact of LUS-BL-guided intensive HF management on the outcome of discharged HF patients with residual LUS-BL up to 1 year after discharge in the era of sodium-glucose cotransporter-2 inhibitors and angiotensin receptor blocker-neprilysin inhibitor.
Trial registration:
ClinicalTrials.gov: NCT05035459.
Background
Lung ultrasound (LUS) is often used to assess congestion in heart failure (HF). In this study, we assessed the prognostic role of LUS in HF patients at admission and hospital discharge, and in an out-patient setting and explored whether clinical factors (age, sex, left ventricular ejection fraction (LVEF) and atrial fibrillation) impact the prognostic value of LUS findings. Further, we assessed the incremental prognostic value of LUS on top of AHEAD and MAGGIC clinical risk scores.
Methods and Results
We pooled data of patients hospitalized for HF or followed-up in out-patient clinics from international cohorts. We enrolled 1,947 patients, at admission (n=578), discharge (n=389) and in out-patient clinic (n=980). Total LUS B-line count was calculated for the 8-zone scanning protocol. The primary outcome was a composite of re-hospitalization for HF and all-cause death. Compared to those in the lower tertiles of B-lines, patients in the highest tertile were older, more likely to have signs of HF and higher NT-proBNP levels. A higher number of B-lines was associated with increased risk of primary outcome at discharge (Tertile3 vs Tertile1: adjustedHR= 5.74 (3.26- 10.12), p<0.0001) and in out-patients (Tertile3 vs Tertile1: adjustedHR= 2.66 (1.08- 6.54), p=0.033). Age and LVEF did not influence the prognostic capacity of LUS in different clinical settings. Adding B-line count to MAGGIC and AHEAD scores improved net reclassification significantly in all three clinical settings.
Conclusion
A higher number of B-lines in patients with HF was associated with increased risk of morbidity and mortality, regardless of the clinical setting.
