Pulmonary congestion evaluated by lung ultrasound predicts decompensation in heart failure outpatients.
BACKGROUND
Pulmonary congestion is the main cause of hospital admission among heart failure (HF) patients. Lung ultrasound (LUS) assessment of B-lines has been recently proposed as a reliable and easy tool for evaluating pulmonary congestion.


OBJECTIVE
To determine the prognostic value of LUS in predicting adverse events in HF outpatients.


METHODS
Single-center prospective cohort of 97 moderate-to-severe systolic HF patients (53±13years; 61% males) consecutively enrolled between November 2011 and October 2012. LUS evaluation was performed during the regular outpatient visit to evaluate the presence of pulmonary congestion, determined by B-lines number. Patients were followed up for 4months to assess admission due to acute pulmonary edema.


RESULTS
During follow-up period (106±12days), 21 hospitalizations for acute pulmonary edema occurred. At Cox regression analysis, B-lines number≥30 (HR 8.62; 95%CI: 1.8-40.1; p=0.006) identified a group at high risk for acute pulmonary edema admission at 120days, and was the strongest predictor of events compared to other established clinical, laboratory and instrumental findings. No acute pulmonary edema occurred in patients without significant pulmonary congestion at LUS (number of B-lines<15).


CONCLUSION
In a HF outpatient setting, B-line assessment by LUS identifies patients more likely to be admitted for decompensated HF in the following 4months. This simple evaluation could allow prompt therapy optimization in those patients who, although asymptomatic, carry a significant degree of extravascular lung water.


CONDENSED ABSTRACT
Pulmonary congestion is the main cause of hospital admissions among heart failure patients. Lung ultrasound can be used as a reliable and easy way to evaluate pulmonary congestion through assessment of B-lines. In a cohort of heart failure outpatients, a B-lines cutoff≥30 (HR 8.62; 95%CI: 1.8-40.1) identified patients most likely to develop acute pulmonary edema at 120-days.
['Miglioranza|Marcelo H|MH|', 'Picano|Eugenio|E|', 'Badano|Luigi P|LP|', "Sant'Anna|Roberto|R|", 'Rover|Marciane|M|', 'Zaffaroni|Facundo|F|', 'Sicari|Rosa|R|', 'Kalil|Renato K|RK|', 'Leiria|Tiago L|TL|', 'Gargani|Luna|L|']
D000328:Adult D000368:Aged D015331:Cohort Studies D005260:Female D005500:Follow-Up Studies D006333:Heart Failure D006760:Hospitalization D006801:Humans D008168:Lung D008297:Male D008875:Middle Aged D010044:Outpatient Clinics, Hospital D011237:Predictive Value of Tests D011446:Prospective Studies D011654:Pulmonary Edema D014463:Ultrasonography
Pulmonary congestion Lung ultrasound Heart failure B-lines Acute pulmonary edema Ultrasound lung comets