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Observational Study
. 2016 Apr 14;37(15):1244-51.
doi: 10.1093/eurheartj/ehv745. Epub 2016 Jan 26.

Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients

Elke Platz  1 , Eldrin F Lewis  2 , Hajime Uno  3 , Julie Peck  4 , Emanuele Pivetta  5 , Allison A Merz  6 , Dorothea Hempel  7 , Christina Wilson  8 , Sarah E Frasure  9 , Pardeep S Jhund  10 , Susan Cheng  2 , Scott D Solomon  2
Affiliations
Observational Study

Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients

Elke Platz et al. Eur Heart J. .

Abstract

Aims: Pulmonary congestion is a common and important finding in heart failure (HF). While clinical examination and chest radiography are insensitive, lung ultrasound (LUS) is a novel technique that may detect and quantify subclinical pulmonary congestion. We sought to independently relate LUS and clinical findings to 6-month HF hospitalizations and all-cause mortality (composite primary outcome).

Methods: We used LUS to examine 195 NYHA class II-IV HF patients (median age 66, 61% men, 74% white, ejection fraction 34%) during routine cardiology outpatient visits. Lung ultrasound was performed in eight chest zones with a pocket ultrasound device (median exam duration 2 min) and analysed offline.

Results: In 185 patients with adequate LUS images in all zones, the sum of B-lines (vertical lines on LUS) ranged from 0 to 13. B-lines, analysed by tertiles, were associated with clinical and laboratory markers of congestion. Thirty-two per cent of patients demonstrated ≥3 B-lines on LUS, yet 81% of these patients had no findings on auscultation. During the follow-up period, 50 patients (27%) were hospitalized for HF or died. Patients in the third tertile (≥3 B-lines) had a four-fold higher risk of the primary outcome (adjusted HR 4.08, 95% confidence interval, CI 1.95, 8.54; P < 0.001) compared with those in the first tertile and spent a significantly lower number of days alive and out of the hospital (125 days vs. 165 days; adjusted P < 0.001).

Conclusions: Pulmonary congestion assessed by ultrasound is prevalent in ambulatory patients with chronic HF, is associated with other features of clinical congestion, and identifies those who have worse prognosis.

Keywords: Heart failure; Lung ultrasound; Prognosis; Pulmonary congestion.

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Figures

Figure 1
Figure 1
Study flow chart. Detailing heart failure patients included in the analysis. HF, heart failure; LUS, lung ultrasound.
Figure 2
Figure 2
Percentage of patients with and without primary outcome event and findings on auscultation (crackles) vs. lung ultrasound (B-lines).
Figure 3
Figure 3
Cumulative incidence of primary and secondary outcome by B-line tertiles.
See this image and copyright information in PMC

Comment in

References

    1. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, Ikonomidis JS, Khavjou O, Konstam MA, Maddox TM, Nichol G, Pham M, Pina IL, Trogdon JG. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 2013;6:606–619. - PMC - PubMed
    1. Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JE, Cleland JG, Dickstein K, Drazner MH, Fonarow GC, Jaarsma T, Jondeau G, Sendon JL, Mebazaa A, Metra M, Nieminen M, Pang PS, Seferovic P, Stevenson LW, van Veldhuisen DJ, Zannad F, Anker SD, Rhodes A, McMurray JJ, Filippatos G. Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 2010;12:423–433. - PubMed
    1. Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. J Am Med Assoc 1989;261:884–888. - PubMed
    1. Platz E, Jhund PS, Campbell RT, McMurray JJ. Assessment and prevalence of pulmonary oedema in contemporary acute heart failure trials: a systematic review. Eur J Heart Fail 2015;17:906–916. - PMC - PubMed
    1. Al Deeb M, Barbic S, Featherstone R, Dankoff J, Barbic D. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med 2014;21:843–852. - PubMed

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