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

Platz, E. et al. (2016) Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients. European Heart Journal, 37(15), pp. 1244-1251. (doi: 10.1093/eurheartj/ehv745) (PMID:26819225) (PMCID:PMC5006102)

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.

• Item Type: Articles
• Additional Information: This work was supported by grants from the Eleanor and Miles Shore Fellowship (E.P.) and the American Heart Association (grant number 13CRP14330000) (E.P.). The writing of this manuscript was supported by a grant from the National Heart, Lung and Blood Institute (grant number 1K23HL123533-01A1) (E.P.).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jhund, Professor Pardeep
• Authors: Platz, E., Lewis, E. F., Uno, H., Peck, J., Pivetta, E., Merz, A. A., Hempel, D., Wilson, C., Frasure, S. E., Jhund, P. S., Cheng, S., and Solomon, S. D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Heart Journal
• Publisher: Oxford University Press
• ISSN: 0195-668X
• ISSN (Online): 1522-9645
• Published Online: 26 January 2016