37 Point-of-Care Lung Ultrasound to Predict Hospital Re-admission Rates in Patients With Acute Heart Failure Exacerbations

Background and Objectives: Acute dyspnea is a common chief complaint in the emergency department (ED), with acute heart failure (AHF) as a frequent underlying disease. Early diagnosis and rapid therapy are highly recommended by international guidelines. This study evaluates the accuracy of point-of-care B-line lung ultrasound in diagnosing AHF and monitoring the therapeutic success of heart failure patients. Materials and Methods: This is a prospective mono-center study in adult patients presenting with undifferentiated acute dyspnea to a German ED. An eight-zone pulmonary ultrasound was performed by experienced sonographers in the ED and 24 and 72 h after. Along with the lung ultrasound evaluation patients were asked to assess the severity of shortness of breath on a numeric rating scale. The treating ED physicians were asked to assess the probability of AHF as the underlying cause. Final diagnosis was adjudicated by two independent experts. Follow-up was done after 30 and 180 days. Results: In total, 102 patients were enrolled. Of them, 89 patients received lung ultrasound evaluation in the ED. The sensitivity of lung ultrasound evaluation in ED in diagnosing AHF was 54.2%, specificity 97.6%. As much as 96.3% of patients with a positive LUS test result for AHF in ED actually suffered from AHF. Excluding diuretically pretreated patients, sensitivity of LUS increased to 75% in ED. Differences in the sum of B-lines between admission time point, 24 and 72 h were not statistically significant. There were no statistically significant differences in the subjectively assessed severity of dyspnea between AHF patients and those with other causes of dyspnea. Of the 89 patients, 48 patients received the final adjudicated diagnosis of AHF. ED physicians assessed the probability of AHF in patients with a final diagnosis of AHF as 70%. Roughly a quarter (23.9%) of the overall cohort patients were rehospitalized within 30 days after admission, 38.6% within 180 days of follow-up. Conclusion: In conclusion, point-of-care lung ultrasound is a helpful tool for the early rule-in of acute heart failure in ED but only partially suitable for exclusion. Of note, the present study shows no significant changes in the number of B-lines after 24 and 72 h.

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Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure

Ultrasound International Open ◽

10.1055/s-0042-108343 ◽

2016 ◽

Vol 02 (03) ◽

pp. E90-E92 ◽

Cited By ~ 5

Author(s):

E. Glöckner ◽

M. Christ ◽

F. Geier ◽

P. Otte ◽

U. Thiem ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

Point Of Care

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Investigating Reduction of aCute heArt Failure Readmission With Lung UltraSound-preliminary Trial

Case Medical Research ◽

10.31525/ct1-nct04174794 ◽

2019 ◽

Author(s):

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

Preliminary Trial

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Assessing congestion in acute heart failure using cardiac and lung ultrasound - a review

Expert Review of Cardiovascular Therapy ◽

10.1080/14779072.2021.1865155 ◽

2021 ◽

pp. 1-12

Author(s):

Øyvind Johannessen ◽

Peder L. Myhre ◽

Torbjørn Omland

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Lung Ultrasound

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Comparison of lung bedside ultrasound and BNP in the diagnosis of acute heart failure in the emergency department

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2020.050 ◽

2020 ◽

Vol 8 (1) ◽

pp. 50-50

Author(s):

Seyed Hossein Ojaghi Haghighi ◽

Neda Hamed ◽

Shiva Ebrahimi ◽

Jafar Ghobadi ◽

Hoorolnesa Ameli

Keyword(s):

Heart Failure ◽

Emergency Room ◽

Pulmonary Edema ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

P Value ◽

Ultrasound Evaluation ◽

Ultrasound Findings ◽

Medical Advances ◽

B Lines

Introduction: Congestive heart failure is heart muscle failure that causes pulmonary congestion and eventually pulmonary edema, which despite recent medical advances, is still a progressive syndrome with high mortality, the prevalence of which has increased in recent decades. Therefore, in this study we compared lung ultrasound findings in acute heart failure patients with the BNP. Methods: This study was performed in the emergency room of Imam Reza hospital in Tabriz. For patients entering the emergency room after taking a history, both standard gold (BNP) tests and beside ultrasound of the lung were performed. Ultrasound was performed at the same time as obtaining blood sample to ensure that the ultrasound specialist did not know the result of diagnosis. During the ultrasound, if there were multiple B-Lines that were at least 3 mm apart, patient was diagnosed with pulmonary edema due to heart failure. Results: Number of participants in this study was 108 people, 54.6% of whom were men and the rest were women. The correlation coefficient between width and number of kerley lines was 0.79, between NT-pro BNP and width of kerley lines was 0.65 and between NT-pro BNP and number of kerley lines was 0.77, which indicates a significant positive correlation (P value <0.001). Conclusion: The results of present study showed that in patients with acute heart failure, the number and width of kerley lines in pulmonary ultrasound evaluation increase rapidly. There is also a high correlation between number and length of kerley lines with NT-pro BNP serum values.

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Abstract 15507: Trajectories of Point of Care B-type Natriuretic Peptide (bnp) and Its Role as a Predictor of All-cause Mortality Among Hiv and Non-hiv Heart Failure Patients in Uganda

Circulation ◽

10.1161/circ.142.suppl_3.15507 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Samson Okello ◽

Fardous C Abeya

Keyword(s):

Heart Failure ◽

Renal Failure ◽

Acute Heart Failure ◽

Natriuretic Peptide ◽

Point Of Care ◽

Antiplatelet Agents ◽

Infected People ◽

Serial Measurement ◽

All Cause Mortality ◽

Hiv Serostatus

Introduction: The usefulness of serial measurement of BNP to reduce hospitalization or mortality in patients with HIV and heartfailure is unknown. Hypothesis: We sought to describe changes in B-type natriuretic peptide (BNP) and estimate the effect of HIV on BNP over a week of observation in an acute heart failure cohort of 40 HIV-infected adults (≥18 years) on antiretroviral therapy (ART) and 175 HIV-uninfected hospitalized patients in Uganda. Methods: We measured BNP using i-STAT BNP (Abbott point of care, Princeton, New Jersey) and compared changes by HIV serostatus, and evaluated BNP as a predictor of all-cause mortality at 30 days from hospitalization using multilevel mixed and competitive risk regression models respectively. Results: Overall HIV-infected participants had a higher mean BNP than HIV-uninfected counterparts. After initial declines in BNP in both groups between day 0 and day 3, BNP moderately increased among the HIV-infected on day 7 and continued to decline in the HIV-uninfected group. Each 1 pg/mL increase in baseline BNP from 400 pg/mL increased the risk of all-cause mortality within 30 days by 1% (adjusted standardized hazard ratio (aSHR) 1.01, 95%CI 1.01, 1.01). Other predictors of increased 30-day all-cause mortality included smoking (aSHR 1.99, 95%CI 1.04, 3.84), hypotension (aSHR 1.69, 95%CI 1.26, 2.26) and renal failure stage 3 (aSHR 2.06, 95%CI 1.34, 3.18), and renal failure stage 5 (aSHR 2.02, 95%CI 1.30, 3.13). We found a lower risk of 30-day all-cause mortality of 38% (95%CI 20%, 73%) for those receiving loop diuretics and 74% (95%CI 56%, 99%) for antiplatelet agents. Conclusions: Over a week of observation, HIV-infected people hospitalized with acute heart failure in Uganda have higher BNP levels than HIV-uninfected counterparts. Increases in BNP above the upper bound of the normal predicted heightened risk of all-cause mortality within 30 days of hospitalization.

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