Abstract
Background
Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing healthcare burden and its prevalence is increasing. Diagnosing HFpEF is challenging. Lung ultrasound (LUS) and left atrial strain are promising screening tools to assess pulmonary congestion and left atrial dysfunction in patients with suspected HFpEF.
Aim
To evaluate the relationship between LUS, left atrial strain and NT-proBNP level in patients with HFpEF. Also to assess the diagnostic power of B-lines in HFpEF population.
Methods
Forty-seven consecutive patients (24 women, mean age 69 ± 11 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction <55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-PALS), lung ultrasound assessment of B-lines on the antero-lateral and posterior chest wall, and NT-proBNP levels.
Results
In 34 patients (72%) a significant number of B-lines (≥15) were observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p < 0,0001, r = 0,74, Figure 1.), left atrial volume (p < 0,05, r = 0,45), and PALS (p < 0,02, r = 0,4 ). We didn’t found any correlation between the number of B-lines and E/e’ ratio (p = 0,1, r = 0,28), or between E/e’ ratio and NT-proBNP level (p = 0,1, r = 0,2). We also assessed the diagnostic ability of ≥15 B-lines to predict markedly elevated pro-BNP level (≥ 220pg/ml), AUC was 0.89. If the total number of B-lines was greater or equal to 28, the sensitivity was 68% with the specificity of 100%, but if we changed the cut-off value to 12, the sensitivity grew to 89% with the specificity of 71%. (Figure 2.).
Conclusion
LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it has a strong diagnostic power to predict elevated NTpro-BNP level. B-lines correlate with parameters of left atrial dysfunction. PALS is promising too, which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameter E/e’.
Abstract P1586 Figure. NT-pBNP vs B-lines, AUC of Blines
Faculty Opinions recommendation of Energetic Basis for Exercise-Induced Pulmonary Congestion in Heart Failure With Preserved Ejection Fraction.
