Prognostic Role of Ultrasound Diagnostic Methods in Patients with Acute Decompensated Heart Failure

Abstract

Objectives: To evaluate the prognostic value (total mortality + repeated hospitalization for heart failure (HF)) of ultrasound diagnostic methods in patients with acute decompensated HF (ADHF).

Methods: The subjects were patients with chronic HF, who were hospitalized for ADHF. Using ultrasound methods-lung ultrasound, ultrasound assessment of hepatic venous congestion as per the venous excess ultrasound (VExUS) protocol, and indirect elastometry-we assessed the number of B-lines, hepatic venous congestion, and liver density of the patients. Clinical outcomes were assessed using a structured telephone survey method at 1, 3, 6, and 12 months after discharge. Combined overall mortality and readmission rates associated with HF were assessed. Threshold values for different methods for detecting congestion were set as follows: the number of B-lines in ultrasound data > 5; liver density > 6.2 kPa.

Results: The subjects were 207 patients (54.1% male; mean age = 70.7 ± 12.8 years). A total of 63 (30.4%) endpoints and 23 (11.1%) deaths were detected within 364 days (IQR = 197-365). Liver density > 6.2 kPa had a hazard ratio (HR) of 1.9 (95% CI: 1.0-3.3; p = 0.029). Hepatic venous congestion (VExUS protocol) had HR of 2.8 (95% CI: 1.3-5.7; p = 0.004). There was a significant increase in the risk of overall prognostic value in the presence of congestion, identified by liver fibroelastometry + lung ultrasound (HR = 10.5, 95% CI: 2.3-46.2; p = 0.002). The ultrasound assessment of hepatic venous congestion (VExUS + lung ultrasound protocol) yielded HR of 16.7 (95% CI: 3.9-70.7; p < 0.001). For all three methods combined, the overall HR was 40.1 (95% CI: 6.6-243.1; p < 0.001).

Conclusions: A combination of ultrasound diagnostic methods that include the number of B-lines, presence of hepatic venous congestion according to the VExUS protocol, and liver density according to indirect elastometry at discharge may have an independent prognostic value for patients with ADHF.

Keywords: Assessment, Patient Outcomes; Heart Failure; Prognosisl; Survival.

Figure 1

Assessment of hepatic venous congestion using Dopplerography.

Figure 2

Kaplan-Meyer curves of cumulative probability of survival (total mortality + re-hospitalization) depending on the presence of pulmonary congestion according to ultrasound data.

Figure 3

Kaplan-Meyer curves of cumulative probability of survival (total mortality + re-hospitalization) depending on liver density according to indirect elastometry.

Figure 4

Kaplan-Meyer curves of cumulative survival probability (total mortality + re-hospitalization) depending on the presence of hepatic venous congestion according to the VExUS protocol.

Figure 5

Kaplan-Meyer curves of cumulative survival probability (total mortality+ rehospitalization) depending on the number of methods used to assess congestion.