Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
Por:
Rivas-Lasarte, M, Maestro, A, Fernandez-Martinez, J, Lopez-Lopez, L, Sole-Gonzalez, E, Vives-Borras, M, Montero, S, Mesado, N, Pirla, MJ, Mirabet, S, Fluvia, P, Brossa, V, Sionis, A, Roig, E, Cinca, J, Alvarez-Garcia, J
Publicada:
1 oct 2020
Ahead of Print:
1 jul 2020
Resumen:
Aims Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in patients admitted for acute HF. Methods and results This is a post-hoc analysis of the LUS-HF trial. LUS was performed by the investigators in eight chest zones with a pocket device. Physical exam was subsequently performed by the treating physicians. Primary outcome was a combined endpoint of rehospitalization, unexpected visit for HF worsening or death at 6- month follow-up. Subclinical pulmonary congestion at discharge was defined as the presence of >= 5 B-lines in LUS in absence of rales in the auscultation employing the area under the ROC curve. At discharge, 100 patients (81%) did not show clinical signs of pulmonary congestion. Of these, 41 had >= 5 B-lines. Independent factors related with the presence of subclinical pulmonary congestion were anaemia, higher New York Heart Association (NYHA) class, and N terminal pro brain natriuretic peptide (NT-proBNP). After adjusting by propensity score analysis including age, renal insufficiency, atrial fibrillation, NYHA class, NT-proBNP levels, clinical congestion, and the trial intervention, the presence of subclinical pulmonary congestion at discharge was a risk factor for the occurrence of the primary outcome (hazard ratio 2.63; 95% confidence interval: 1.08-6.41;P = 0.033). Conclusions Up to 40% of patients considered 'dry' according to pulmonary auscultation presents subclinical congestion at hospital discharge that can be detected by LUS and implies a worse prognosis at 6- month follow-up. Comorbidities, high values of natriuretic peptides, and higher NYHA class are the factors related with its presence.
Filiaciones:
Rivas-Lasarte, M:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Maestro, A:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Fernandez-Martinez, J:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Lopez-Lopez, L:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Sole-Gonzalez, E:
Hosp Mar, Cardiol Dept, Barcelona, Spain
Vives-Borras, M:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Montero, S:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
Mesado, N:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Pirla, MJ:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Mirabet, S:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Fluvia, P:
Hosp Doctor Josep Trueta, Cardiol Dept, Girona, Spain
Brossa, V:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Sionis, A:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Roig, E:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Cinca, J:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
Alvarez-Garcia, J:
Univ Autonoma Barcelona, CIBERCV, Cardiol Dept, Hosp Santa Creu & St Pau,Ilb St Pau, Barcelona, Spain
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