Lung ultrasound in outpatients with heart failure: the wet-to-dry HF study
Por:
Domingo, M, Lupon, J, Girerd, N, Conangla, L, De Antonio, M, Moliner, P, Santiago-Vacas, E, Codina, P, Cediel, G, Spitaleri, G, Gonzalez, B, Diaz, V, Rivas, C, Velayos, P, Nunez, J, Bayes-Genis, A
Publicada:
1 dic 2021
Ahead of Print:
1 nov 2021
Resumen:
Aims In ambulatory patients with chronic heart failure (HF), congestion and decongestion assessment may be challenging. The aim of this study is to assess the value of lung ultrasound (LUS) in outpatients with HF in characterizing decompensation and recompensation, and in outcomes prediction.
Methods and results Heart failure outpatients attended to establish HF decompensation were included. LUS was blindly performed at baseline (LUS1) and at clinical recompensation (LUS2). B-lines were counted in eight scanned areas. Diagnosis of no HF decompensation vs. right-sided, left-sided, or global HF decompensation, and patients' management were performed by physicians blinded to LUS1. Outcome was the composite of all-cause death or HF-related hospitalization. Two hundred and thirty-three suspicions of HF decompensation were included in 187 patients (71.4 +/- 11.3 years, 66.8% men). Mean B-line (LUS1) was 17.6 +/- 11.2 vs. 3.7 +/- 4.5 for episodes with and without HF decompensation, respectively (P < 0.001). Global HF decompensation showed the highest number of B-lines (20.6 +/- 11), followed by left-sided (19.7 +/- 11.6) and right-sided (13.5 +/- 9.8). B-lines declined to 6.9 +/- 6.7 (LUS2) (P < 0.001 vs. LUS1) after treatment, within a mean time of 24.2 +/- 23.7 days [median 13.5 days (interquartile range 6-40)]. B-lines were significantly associated with the composite endpoint at 30 days (hazard ratio [HR] 1.04 [95% confidence interval 1.01-1.07], P = 0.02), but not at 60 (P = 0.22) or 180 days (P = 0.54). In multivariable analysis, B-line number remained as an independent predictor of the composite endpoint at 30 days, [HR 1.04 (1.01-1.07), P = 0.014], with a 4% increase risk per B-line added. B-lines correlated significantly with CA125 (R = 0.30, P = 0.001).
Conclusions Lung ultrasound supports the diagnostic work-up of congestion and decongestion in chronic HF outpatients and identifies patients at high risk of short-term events.
Filiaciones:
Domingo, M:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Lupon, J:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Girerd, N:
Univ Lorraine, Ctr Invest Clin Plurithemat 1433, CHRU Nancy, INSERM,DCAC,F CRIN,INI,CRCT, Vandoeuvre Les Nancy, France
Conangla, L:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
De Antonio, M:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Moliner, P:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Santiago-Vacas, E:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Codina, P:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Cediel, G:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Spitaleri, G:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Gonzalez, B:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Diaz, V:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Rivas, C:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Velayos, P:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Nunez, J:
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Hosp Clin Univ, INCLIVA, Cardiol Dept, Valencia, Spain
Univ Valencia, Dept Med, Valencia, Spain
Bayes-Genis, A:
Germans Trias & Pujol Hosp, Cardiol Serv, Heart Failure Clin, Carretera Canyet S-N, Barcelona 08916, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
gold, Green Published
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