The incremental value of multi-organ assessment of congestion using ultrasound in outpatients with heart failure

Pugliese, N. R. et al. (2023) The incremental value of multi-organ assessment of congestion using ultrasound in outpatients with heart failure. European Heart Journal: Cardiovascular Imaging, (doi: 10.1093/ehjci/jeac254) (PMID:36595324) (Early Online Publication)

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Aims: We investigated the prevalence and clinical value of assessing multi-organ congestion by ultrasound in heart failure (HF) outpatients. Methods and results: Ultrasound congestion was defined as inferior vena cava of ≥21 mm, highest tertile of lung B-lines, or discontinuous renal venous flow. Associations with clinical characteristics and prognosis were explored. We enrolled 310 HF patients [median age: 77 years, median NT-proBNP: 1037 ng/L, 51% with a left ventricular ejection fraction (LVEF) <50%], and 101 patients without HF. There were no clinical signs of congestion in 224 (72%) patients with HF, of whom 95 (42%) had at least one sign of congestion by ultrasound (P < 0.0001). HF patients with ≥2 ultrasound signs were older, and had greater neurohormonal activation, lower urinary sodium concentration, and larger left atria despite similar LVEF. During a median follow-up of 13 (interquartile range: 6–15) months, 77 patients (19%) died or were hospitalized for HF. HF patients without ultrasound evidence of congestion had a similar outcome to patients without HF [reference; hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.86–1.35], while those with ≥2 ultrasound signs had the worst outcome (HR 26.7, 95% CI 12.4–63.6), even after adjusting for multiple clinical variables and NT-proBNP. Adding multi-organ assessment of congestion by ultrasound to a clinical model, including NT-proBNP, provided a net reclassification improvement of 28% (P = 0.03). Conclusion: Simultaneous assessment of pulmonary, venous, and kidney congestion by ultrasound is feasible, fast, and identifies a high prevalence of sub-clinical congestion associated with poor outcomes.

Item Type:Articles
Status:Early Online Publication
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Pugliese, N. R., Pellicori, P., Filidei, F., Del Punta, L., De Biase, N., Balletti, A., Di Fiore, V., Mengozzi, A., Taddei, S., Gargani, L., Mullens, W., Cleland, J. G.F., and Masi, S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Heart Journal: Cardiovascular Imaging
Publisher:Oxford University Press
ISSN (Online):2047-2412
Published Online:03 January 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in European Heart Journal: Cardiovascular Imaging 2023
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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