The prevalence and clinical associations of ultrasound measures of congestion in patients at risk of developing heart failure

Cuthbert, J. J., Pellicori, P. , Flockton, R., Kallvikbacka-Bennett, A., Khan, J., Rigby, A. S., Girerd, N., Zannad, F., Cleland, J. G.F. and Clark, A. L. (2021) The prevalence and clinical associations of ultrasound measures of congestion in patients at risk of developing heart failure. European Journal of Heart Failure, 23(11), pp. 1831-1840. (doi: 10.1002/ejhf.2353) (PMID:34632680)

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Abstract

Aims: Congestion is a cardinal feature of untreated heart failure (HF) and might be detected by ultrasound (US) before overt clinical signs appear. Methods and results: We investigated the prevalence and clinical associations of subclinical congestion in 238 patients with at least one clinical risk factor for HF (diabetes, ischaemic heart disease, or hypertension) using three US variables: (i) inferior vena cava (IVC) diameter; (ii) jugular vein distensibility (JVD) ratio (the ratio of the jugular vein diameter during the Valsalva manoeuvre to that at rest); (iii) the number of B-lines from a 28-point lung US. US congestion was defined as IVC diameter > 2.0 cm, JVD ratio < 4.0 or B-lines count > 14. The prevalence of subclinical congestion (defined as at least one positive US marker of congestion) was 30% (13% by IVC diameter, 9% by JVD ratio and 13% by B-line quantification). Compared to patients with no congestion on US, those with at least one marker had larger left atria and higher plasma concentrations of natriuretic peptides. Patients with raised plasma N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide had a lower JVD ratio (7.69 vs. 8.80; P = 0.05) and more often had at least one lung B-line (74% vs. 63%; P = 0.05). However, plasma natriuretic peptide concentrations were more closely related to left atrial volume than other US measures of congestion. Conclusions: Subclinical evidence of congestion by US is common in patients with clinical risk factors for HF. Whether these measurements provide additional value for predicting the development of HF and its prevention deserves consideration.

Item Type:Articles
Additional Information:Funding: This work was funded by the European Union 7th Framework Programme for Research and Technological Development grant 305507 (http://www.homage-hf.eu) and analysis supported by a British Heart Foundation Centre of Research Excellence award RE/18/6/34217.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Cuthbert, J. J., Pellicori, P., Flockton, R., Kallvikbacka-Bennett, A., Khan, J., Rigby, A. S., Girerd, N., Zannad, F., Cleland, J. G.F., and Clark, A. L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:10 October 2021
Copyright Holders:Copyright © 2021 European Society of Cardiology
First Published:First published in European Journal of Heart Failure 23(11): 1831-1840
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
190666HOMAGE: Heart OMics in AGEingChristian DellesEuropean Commission (EC)305507Institute of Cardiovascular & Medical Sciences