Trajectory and correlates of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction: insights from PARADISE-MI

Platz, E. et al. (2023) Trajectory and correlates of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction: insights from PARADISE-MI. European Heart Journal: Acute Cardiovascular Care, 12(3), pp. 155-164. (doi: 10.1093/ehjacc/zuad001) (PMID:36649251)

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Background: PARADISE-MI examined the efficacy of sacubitril/valsartan in acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both. We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a prespecified substudy. Methods: Patients without prior heart failure (HF) underwent 8-zone LUS and echocardiography at baseline (±2 days of randomization) and after 8 months. B-lines were quantified offline, blinded to treatment, clinical findings, timepoint and outcomes. Results: Among 152 patients (median age 65, 32% women, mean LVEF 41%), B-lines were detectable in 87% at baseline (median B-line count: 4 [IQR 2-8]). Among 115 patients with LUS data at baseline and follow-up, B-lines decreased significantly from baseline (mean ± SD: -1.6 ± 7.3; p=0.018). The proportion of patients without pulmonary congestion at follow-up was significantly higher in those with fewer B-lines at baseline. Adjusted for baseline, B-lines at follow-up were on average 6 (95% CI: 3, 9) higher in patients who experienced an intercurrent HF event vs. those who did not (p=0.001). A greater number of B-lines at baseline was associated with larger left atrial size, higher E/e’ and E/A ratios, greater degree of mitral regurgitation, worse right ventricular systolic function, and higher tricuspid regurgitation velocity (p trend <0.05 for all). Conclusions: In this AMI cohort, B-lines, indicating pulmonary congestion, were common at baseline and, on average, decreased significantly from baseline to follow-up. Worse pulmonary congestion was associated with prognostically important echocardiographic markers.

Item Type:Articles
Additional Information:The PARADISE-MI trial was funded by Novartis. Dr. Platz was also supported by NHLBI grant R01HL148439.
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Kober, Professor Lars
Authors: Platz, E., Claggett, B., Jering, K. S., Kovacs, A., Cikes, M., Winzer, E. B., Rad, A., Lefkowitz, M. P., Gong, J., Køber, L., McMurray, J. J.V., Solomon, S. D., Pfeffer, M. A., and Shah, A.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Heart Journal: Acute Cardiovascular Care
Publisher:Oxford University Press
ISSN (Online):2048-8734
Published Online:17 January 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in European Heart Journal: Acute Cardiovascular Care 12(3): 155-164
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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