Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure
Identifieur interne : 000779 ( Main/Exploration ); précédent : 000778; suivant : 000780Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure
Auteurs : Stefano Coiro [Italie, France] ; Patrick Rossignol [France] ; Giuseppe Ambrosio [Italie] ; Erberto Carluccio [Italie] ; Gianfranco Alunni [Italie] ; Adriano Murrone [Italie] ; Isabella Tritto [Italie] ; Faiez Zannad [France] ; Nicolas Girerd [France]Source :
- European Journal of Heart Failure [ 1388-9842 ] ; 2015-11.
Abstract
Residual pulmonary congestion at discharge is associated with poor prognosis in heart failure (HF), but its quantification through physical examination is challenging. Ultrasound imaging of lung comets (B‐lines) could improve congestion evaluation. The aim of this study was to assess the short‐term prognostic value of B‐lines after discharge from HF hospitalisation compared with other indices of haemodynamic congestion (BNP, E/e', and inferior vena cava diameter) or clinical status (NYHA class).
Sixty consecutive HF inpatients underwent clinical examination, echocardiography, and lung ultrasound at discharge, independently of, and in addition to routine management by the attending physicians. The median B‐line count was 8.5 (5–34). Three‐month event‐free survival for the primary endpoint (all‐cause death or HF hospitalisation) was 27 ± 10% in patients with ≥30 B‐lines and 88 ± 5% in those with <30 B‐lines (P < 0.0001). In a multivariable model, ≥30 B‐lines significantly predicted the combined endpoint (hazard ratio 5.66, 95% confidence interval 1.74–18.39, P = 0.04), along with NYHA ≥III and inferior vena cava diameter, while other indirect measures of congestion (BNP and E/e' ≥15) were not retained in the model; furthermore ≥30 B‐lines independently also predicted the secondary outcomes (HF hospitalisation and death). Importantly, B‐line addition to NYHA class and BNP was associated with improved risk classification (integrated discrimination improvement 15%, P = 0.02; continuous net reclassification improvement 65%, P = 0.03).
Residual pulmonary congestion at discharge, as assessed by a B‐line count ≥30, is a strong predictor of outcome. Lung ultrasonography may represent a useful tool to identify and monitor congestion and optimize therapy during and/or after hospitalisation for HF, which should be further validated in multicentre studies.
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DOI: 10.1002/ejhf.344
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unit="vol">17</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1172">1172</biblScope><biblScope unit="page" to="1181">1181</biblScope><biblScope unit="page-count">10</biblScope><publisher>John Wiley & Sons, Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2015-11">2015-11</date></imprint><idno type="ISSN">1388-9842</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1388-9842</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Residual pulmonary congestion at discharge is associated with poor prognosis in heart failure (HF), but its quantification through physical examination is challenging. Ultrasound imaging of lung comets (B‐lines) could improve congestion evaluation. The aim of this study was to assess the short‐term prognostic value of B‐lines after discharge from HF hospitalisation compared with other indices of haemodynamic congestion (BNP, E/e', and inferior vena cava diameter) or clinical status (NYHA class).</div><div type="abstract">Sixty consecutive HF inpatients underwent clinical examination, echocardiography, and lung ultrasound at discharge, independently of, and in addition to routine management by the attending physicians. The median B‐line count was 8.5 (5–34). Three‐month event‐free survival for the primary endpoint (all‐cause death or HF hospitalisation) was 27 ± 10% in patients with ≥30 B‐lines and 88 ± 5% in those with <30 B‐lines (P < 0.0001). In a multivariable model, ≥30 B‐lines significantly predicted the combined endpoint (hazard ratio 5.66, 95% confidence interval 1.74–18.39, P = 0.04), along with NYHA ≥III and inferior vena cava diameter, while other indirect measures of congestion (BNP and E/e' ≥15) were not retained in the model; furthermore ≥30 B‐lines independently also predicted the secondary outcomes (HF hospitalisation and death). Importantly, B‐line addition to NYHA class and BNP was associated with improved risk classification (integrated discrimination improvement 15%, P = 0.02; continuous net reclassification improvement 65%, P = 0.03).</div><div type="abstract">Residual pulmonary congestion at discharge, as assessed by a B‐line count ≥30, is a strong predictor of outcome. Lung ultrasonography may represent a useful tool to identify and monitor congestion and optimize therapy during and/or after hospitalisation for HF, which should be further validated in multicentre studies.</div></front></TEI><affiliations><list><country><li>France</li><li>Italie</li></country><region><li>Grand Est</li><li>Lorraine (région)</li></region><settlement><li>Metz</li><li>Nancy</li></settlement><orgName><li>Université de Lorraine</li></orgName></list><tree><country name="Italie"><noRegion><name sortKey="Coiro, Stefano" sort="Coiro, Stefano" uniqKey="Coiro S" first="Stefano" last="Coiro">Stefano Coiro</name></noRegion><name sortKey="Alunni, Gianfranco" sort="Alunni, Gianfranco" uniqKey="Alunni G" first="Gianfranco" last="Alunni">Gianfranco Alunni</name><name sortKey="Ambrosio, Giuseppe" sort="Ambrosio, Giuseppe" uniqKey="Ambrosio G" first="Giuseppe" last="Ambrosio">Giuseppe Ambrosio</name><name sortKey="Carluccio, Erberto" sort="Carluccio, Erberto" uniqKey="Carluccio E" first="Erberto" last="Carluccio">Erberto Carluccio</name><name sortKey="Murrone, Adriano" sort="Murrone, Adriano" uniqKey="Murrone A" first="Adriano" last="Murrone">Adriano Murrone</name><name sortKey="Tritto, Isabella" sort="Tritto, Isabella" uniqKey="Tritto I" first="Isabella" last="Tritto">Isabella Tritto</name></country><country name="France"><region name="Grand Est"><name sortKey="Coiro, Stefano" sort="Coiro, Stefano" uniqKey="Coiro S" first="Stefano" last="Coiro">Stefano Coiro</name></region><name sortKey="Coiro, Stefano" sort="Coiro, Stefano" uniqKey="Coiro S" first="Stefano" last="Coiro">Stefano Coiro</name><name sortKey="Girerd, Nicolas" sort="Girerd, Nicolas" uniqKey="Girerd N" first="Nicolas" last="Girerd">Nicolas Girerd</name><name sortKey="Girerd, Nicolas" sort="Girerd, Nicolas" uniqKey="Girerd N" first="Nicolas" last="Girerd">Nicolas Girerd</name><name sortKey="Rossignol, Patrick" sort="Rossignol, Patrick" uniqKey="Rossignol P" first="Patrick" last="Rossignol">Patrick Rossignol</name><name sortKey="Rossignol, Patrick" sort="Rossignol, Patrick" uniqKey="Rossignol P" first="Patrick" last="Rossignol">Patrick Rossignol</name><name sortKey="Zannad, Faiez" sort="Zannad, Faiez" uniqKey="Zannad F" first="Faiez" last="Zannad">Faiez Zannad</name><name sortKey="Zannad, Faiez" sort="Zannad, Faiez" uniqKey="Zannad F" first="Faiez" last="Zannad">Faiez Zannad</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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