scholarly journals The prognostic value of lung ultrasound in aortic stenosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
G Agoston ◽  
I Szabo ◽  
L Gargani ◽  
N Nemeth ◽  
B Morvai-Illes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Pulmonary Congestion ◽  
Severe Aortic Regurgitation ◽  
Increased Risk ◽  
B Lines

Abstract Funding Acknowledgements Type of funding sources: None. Background Aortic stenosis (AS) is a progressive disease and once symptomatic and heart failure (HF) develops is associated with poor prognosis. The degree of the pathophysiological and structural changes in AS are associated with poor survival. Pulmonary congestion is an almost universal finding in patients with HF. Lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, non-invasive tool to assess pulmonary congestion. Aim To assess pulmonary congestion with LUS in patients with AS and to define the prognostic value of B-lines. Methods 84 consecutive patients (43 women, mean age 74 ± 9 years) with moderate or severe AS were enrolled. Exclusion criteria were as follows:  moderate or severe aortic regurgitation, moderate or severe mitral regurgitation, cardiomyopathies, pulmonary disease, renal failure. At baseline, all patients underwent comprehensive echocardiography examination and LUS according to 28 scanning-site assessment. Patients were followed-up after enrollment to establish the prognostic value of LUS. A composite endpoint was considered, including: aortic valve replacement due to deterioration of patient condition or progression of AS from moderate to severe, death (any cause), hospitalization due to acute heart failure or progression of chronic heart failure which required hospitalization. Results We found a  severe number of B-lines (total B-lines ≥30) in 31% of AS patients. The number of B-lines was correlated with estimated pulmonary artery systolic pressure (p < 0,005, r= 0,52) and increased along with NYHA class (p < 0,001) Figure 1. Patients with ≥30 B-lines had more events during the 13,4 ± 6 months follow-up  (p < 0,001, Log-rank: 10,7; Figure 2). Conclusion Assessing B-lines in AS is a simple, feasible method to detect pulmonary congestion. The number of B-lines correlates with hemodynamic changes caused by AS and with the functional status of the patients. A severe degree of sonographic pulmonary congestion is associated with an increased risk of adverse events. Abstract Figure. FC class vs. Blines and prognostic value

scholarly journals Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

2020 ◽  
Vol 25 (1) ◽  
pp. 39-45
Author(s):  
Z. D. Kobalava ◽  
O. I. Lukina ◽  
I. Meray ◽  
S. V. Villevalde
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Systolic Pressure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Arterial Elastance ◽  
Increased Risk ◽  
All Cause Mortality

Aim. To assess ventricular-arterial coupling (VAC) parameters and their prognostic value in patients with decompensated heart failure (HF).Material and methods. VAC parameters were evaluated upon admission using two-dimensional echocardiography in 355 patients hospitalized with decompensated HF. VAC was expressed as the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees). The optimal VAC range was considered 0,6-1,2. Parameters of left ventricular (LV) efficacy were calculated using the appropriate formulas. Differences were considered significant at p<0,05.Results. The median values of Ea, Ees and VAC were 2,2 (1,7;2,9) mmHg/ml, 1,8 (1,0;3,0) mmHg/ml and 1,32 (0,75;2,21) respectively. In 63% of patients, VAC disorders were detected: 55% of patients had VAC >1,2 (predominantly patients with HF with reduced ejection fraction (HFrEF)-79%), 8% of patients had VAC <0,6 (all patients with HF with preserved ejection fraction (HFpEF)). Normal VAC was observed in 78%, 42%, and 1% of patients with HFpEF, HF with mid-range EF and HFrEF, respectively. There was significant correlation between Ea/Ees ratio and levels of NTproBNP (R=0,35), hematocrit (R=-0,29), hemoglobin (R=-0,26), pulmonary artery systolic pressure (PAPs) (R=0,18), dimensions of left atrium (R=0,32) and right ventricle (RV) (R=0,32). After 6 months, rehospitalization with decompensated HF was recorded in 72 (20,3%) patients, 42 (11,8%) patients died. Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg increased the risk of rehospitalization with decompensated HF and all-cause mortality 2,5 and 3,7 times, respectively.Conclusion. Impaired VAC was diagnosed in 63% of patients with decompensated HF. However, the increased risk of all-cause mortality and rehospitalization with decompensated HF over the 6 months was associated with Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg.

scholarly journals The additive prognostic value of B-lines and heart rate reserve during “kindergarten” stress echocardiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A Scali ◽  
Q Ciampi ◽  
A Zagatina ◽  
C Prota ◽  
L Cortigiani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Multivariable Analysis ◽  
Heart Rate Reserve ◽  
Pulmonary Congestion ◽  
Risk Of Death ◽  
Increased Risk ◽  
B Lines

Abstract Background B-lines by lung ultrasound (LUS) were added to stress echo (SE) as a direct sign of pulmonary congestion useful to establish an objective link between dyspnoea symptoms and acute heart failure. They are feasible with “kindergarten” training of few hours and pocket size instruments. Aim To assess the prognostic value of “kindergarten SE” only based on B-lines and imaging-independent heart rate reserve (HRR). Methods We enrolled 2,149 patients (age 63±16 yrs, 831 women, 39%) with known or suspected coronary artery diseasereferred for exercise (n=1,015), dipyridamole (n=1,039), adenosine (n=16) or dobutamine (n=79) SE. By LUS, we adopted the 4-site simplified scan, each site scored from 0=normal A-lines, to 10=coalescing B-lines. HRR was assessed as peak/rest ratio of heart rate. All patients were followed-up. Results Interpretable HRR and LUS data were obtained in all patients (feasibility=100%). Abnormal B-lines (≥2) at peak stress were present in 756 patients (35%). Abnormal HRR (≤1.80 for exercise and dobutamine and ≤1.22 for vasodilator) was found in 986 patients (46%), both positivity in 388 patients (18%). During a median follow-up time of 15 months, 137 spontaneous events occurred in 120 patients: 38 deaths, 28 myocardial infarctions, 60 acute heart failures, 11 strokes. B-lines ≥2 and/or reduced HRR were independently associated with adverse outcome (see figure). At multivariable analysis, a three-fold increased risk of death was observed when both B-lines and HRR were abnormal (Hazard ratio: 3.097, 95% Confidence Intervals 1.095–8.754, p=0.03). Conclusions A super-simplified stress test (“SE without SE”) with simple heart rate assessment by EKG and LUS for B-lines evaluates key variables such as chronotropic incompetence (due to reduced sympathetic reserve) and pulmonary congestion (due to backward acute heart failure) and allows an accurate prediction of outcome. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals P1479 Prognostic value of integrated cardiopulmonary ultrasound in heart failure patients with reduced and preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Gargani ◽  
N Pugliese ◽  
F Frassi ◽  
S Masi ◽  
P Landi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Univariate Analysis ◽  
Vena Cava ◽  
Pulmonary Congestion ◽  
Echocardiographic Parameters ◽  
Ultrasound Assessment ◽  
B Lines

Abstract Background Lung-ultrasound B-lines are the sonographic sign of pulmonary congestion and are present in patients with heart failure (HF). Their role as a diagnostic marker is quite established since they can be used for the differential diagnosis of dyspnea to both rule in or rule out HF, whereas their prognostic value at admission is less known. Purpose To assess the prognostic value of B-lines at admission in patients admitted to a Cardiology Department with a diagnosis of HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Methods We enrolled a total of 310 consecutive in-patients (aged 69 ± 12 years, 751 males) who underwent on admission a two-dimensional and Doppler echocardiographic evaluation coupled with lung ultrasound assessment of B-lines, according to standardised protocols. The total number of B-line was obtained by summing the number of B-lines from 28 scanning sites on the anterior and lateral right and left hemithorax, as previously described. Results All patients were followed-up for a median period of 15 (interquartile range: 5-28) months for death and HF readmission. During the follow-up, 79 events occurred. Among standard echocardiographic parameters, ejection fraction (EF) &lt;50%, tricuspid annular plane systolic excursion (TAPSE) &lt; 17 mm, pulmonary artery systolic pressure (PASP) ³35 mmHg, inferior vena cava diameter &gt;21 mm and total B-lines ³30 were predictors of events at univariate analysis, whereas only B-lines ³30 (hazard ratio [HR] 2.06; 95% confidence interval [CI] 1.04-4.10) and TAPSE &lt;17 mm (HR 0.53; CI 0.29-0.97) were independent predictors at multivariate analysis. When analysing separately HFpEF patients (105 patients, 33.9%), B-lines ³30 was the only independent predictor of events (HR 6.11; CI 1.49-25.05) (Figure). Conclusions B-lines are a simple, user-friendly, bedside echographic sign of pulmonary congestion, that provides useful information not only for the diagnosis but also for the prognosis of HF patients. Their added value among standard echocardiographic parameters is stronger in patients with HFpEF compared to HFrEF. An integrated cardiopulmonary ultrasound assessment at HF admission provides excellent value for both diagnostic and prognostic stratification. Abstract P1479 Figure

scholarly journals Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Stefano Coiro ◽  
Guillaume Porot ◽  
Patrick Rossignol ◽  
Giuseppe Ambrosio ◽  
Erberto Carluccio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Poor Prognosis ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Systolic Arterial Pressure ◽  
Lung Ultrasonography ◽  
Pulmonary Congestion ◽  
Prognostic Role ◽  
Heart Failure Hospitalisation ◽  
B Lines

Abstract Pulmonary congestion assessed at discharge by lung ultrasonography predicts poor prognosis in heart failure (HF) patients. We investigated the association of B-lines with indices of hemodynamic congestion [BNP, E/e’, pulmonary systolic arterial pressure (PAPs)] in HF patients, and their prognostic value overall and according to concomitant atrial fibrillation (AF), reduced (≤40%) ejection fraction (EF), and timing of quantification during hospitalisation for heart failure (HHF). In 110 HHF patients, B-lines were highly discriminative of BNP >400 pg/ml (AUC ≥ 0.80 for all), and moderately discriminative of PAPs >50 mmHg (AUC = 0.68, 0.56 to 0.80); conversely, B-lines poorly discriminated average E/e’ ≥ 15, except at discharge. B-line count significantly predicted mid-term recurrent HHF or death (overall and in subgroups), regardless of AF status, EF, and timing of quantification during HHF (all p for interaction >0.10). regardless, B-lines ≥30 at discharge were most predictive of outcome (HR = 7.11, 2.06–24.48; p = 0.002) while B-lines ≥45 early during HHF were most predictive of outcome (HR = 9.20, 1.82–46.61; p = 0.007). Lung ultrasound was able to identify patients with high BNP levels, but not with increased E/e’, also showing a prognostic role regardless of AF status, EF or timing of quantification; best B-line cut-off appears to vary according to the timing of quantification during hospitalization.

scholarly journals P817 Lung ultrasound in the evaluation of pulmonary congestion in patients with aortic stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Szabo ◽  
L Gargani ◽  
B Illes ◽  
A Frigy ◽  
A Varga ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Functional Status ◽  
Lung Ultrasound ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Volume Index ◽  
Pulmonary Congestion ◽  
Interstitial Edema ◽  
Severe Aortic Regurgitation ◽  
B Lines

Abstract Background Aortic stenosis (AS) has a prolonged latent period, as AS worsens, the left ventricular adaptations become inadequate and impaired systolic and/or diastolic dysfunction, may lead to clinical heart failure (HF). The development of HF is an inflexion point in the natural history of AS. Pulmonary congestion is a nearly universal pathophysiological finding in HF, and may precede symptoms. Lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, non-invasive tool to assess pulmonary interstitial edema. Aim To assess pulmonary interstitial edema with LUS in patients with moderate and severe aortic stenosis, to define performance of LUS compared with clinical assessment and echocardiographic parameters. Methods Sixty-eight consecutive patients (36 women, mean age 74 ± 9 years) with moderate or severe aortic stenosis were enrolled. Exclusion criteria were as follows: moderate or severe aortic regurgitation, moderate or severe mitral regurgitation, cardiomyopathies and pulmonary disease. All patients underwent comprehensive echocardiography examination and LUS according to a previously validated 28 scanning-site assessment. Results we found a significant number of B-lines (≥15) in 79% of patients. B-lines were positively correlated with left atrial volume index (p &lt; 0,05, r = 0,3) and estimated pulmonary pressure ( p &lt; 0,0001, r= 0,62 Figure 1.) The number of B-lines didn’t correlate with the severity of AS (mean gradient vs. B-lines: p = 0,2, valve area vs. B-lines: p = 0,2.), however properly reflects different functional status of the patients (p &lt; 0,0001, Figure 2.) Conclusion Lung ultrasound is a promising tool to detect lung congestion related to AS. The severity of congestion doesn’t correlate with the severity of AS, albeit B-lines better reflect the deteriorating functional status of the patients and the haemodynamic consequences related to AS. Abstract P817 Figure. Correlation PASP vs Blines, NYHA/B-lines

P341 Prognostic value of pulmonary congestion assessed by lung ultrasound to predict decompensation in heart failure patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Bidaut ◽  
A Hubert ◽  
E Donal
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Global Longitudinal Strain ◽  
Systolic Pressure ◽  
Pulmonary Congestion ◽  
Kaplan Meier ◽  
Significant Difference ◽  
One Year ◽  
B Lines

Abstract INTRODUCTION : Lung ultrasound (LUS) evaluation of B lines is a valid tool for the assessment of pulmonary congestion in heart failure (HF) patients. The aim of this study was to evaluate the prognosis of HF patients presenting with B lines, with a primary endpoint of rehospitalization for heart failure and/or death at one year. METHOD : 93 patients presenting with significant dyspnea (NYHA ≥ 2) underwent an initial analysis of LUS for B-lines, complete TTE, and were propectively followed up for one year. RESULTS : Data on follow up was obtained for 88 patients. 8 patients presented with HF, and 5 patients died. ROC analysis showed an optimal cutoff of B-lines at 6. Kaplan Meier curves showed a significant difference in rehospitalization for heart failure at 1 year (p = 0,047 for B-lines ≥ 6). There was no significant difference for death. Patients with ≥ 6 B-lines had an OR at 13,7 for HF rehospitalization at 1 year (IC95% , p = 0,017). CONCLUSION : B-lines assessment by LUS identifies patients more likely to be admitted for decompensated HF in the following year. This tool should be considered in a multi-parametric approach in patients with heart failure to optimize treatment and follow up. Baseline characteristics Rehospitalization for HF n = 8 No rehospitalization for HF n = 80 p value Age 75,5 +/-8 71,9 +/-9,7 0,325 BMI 23,6 +/- 2,1 26,8 +/- 5,4 0,005 HF history 8 (100%) 35 (43,8%) &lt;0,001 Significant valvulopathy 8 (100%) 45 (56,3%) &lt;0,001 Renal insufficiency 5 (62,5%) 19 (23,8%) 0,019 NYHA ≥3 7 (87,5%) 17 (21,3%) &lt;0,001 Total B-lines 16,1 +/- 9,5 6,8 +/- 9,7 0,012 B-lines ≥ 6 7 (87,5%) 27 (33,8%) 0,003 LVEF 39,3 +/- 11,7 48,5 +/- 15,5 0,109 GLS -9,4 +/- 3,2 -13,3 +/- 5,5 0,018 Mitral S average 4,5 +/- 1,1 6,1 +/- 1,8 0,017 E/A ratio 3 +/- 1,8 1,2 +/- 0,84 0,05 Peak TR velocity (m/s) 3 +/- 0,47 2,5 +/- 0,5 0,018 PASP (mmhg) 52,6 +/- 16 35,8 +/- 14 0,002 HF : heart failure, BMI : body mass index, NYHA : new york heart association, LVEF : left ventricule ejection fraction, GLS : global longitudinal strain, TR : tricuspid regurgitation, PASP : pulmonary artery systolic pressure Abstract P341 Figure. Kaplan Meier survival curve

scholarly journals Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients

2016 ◽  
Vol 37 (15) ◽  
pp. 1244-1251 ◽  
Author(s):  
Elke Platz ◽  
Eldrin F. Lewis ◽  
Hajime Uno ◽  
Julie Peck ◽  
Emanuele Pivetta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Pulmonary Congestion ◽  
Heart Failure Patients

scholarly journals Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review

2017 ◽  
Vol 19 (9) ◽  
pp. 1154-1163 ◽  
Author(s):  
Elke Platz ◽  
Allison A. Merz ◽  
Pardeep S. Jhund ◽  
Ali Vazir ◽  
Ross Campbell ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Chronic Heart Failure ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Pulmonary Congestion ◽  
Dynamic Changes

scholarly journals PREDISCHAGE LUNG ULTRASOUND AS A PREDICTOR OF REHOSPITALIZATION OR MORTALITY ACUTE HEART FAILURE PATIENTS

2020 ◽  
Vol 7 (8) ◽  
pp. 28-34
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Acute Heart Failure ◽  
Lung Ultrasound ◽  
Independent Predictor ◽  
Hypertensive Heart Disease ◽  
Functional Class ◽  
Pulmonary Congestion ◽  
Class Iii ◽  
B Lines

Backgroud: Persistent congestion is a major cause of rehospitalization in patients with acute heart failure (AHF). Lung Ultrasound (LUS) is an easy and valid examination in assessing pulmonary congestion. The number of B-lines correlates very strongly with the amount of extravascular lung fluid (EVLW). The aim of this study is to determine if LUS pre-discharge can predict rehospitalization or mortality. Methods: This single centered cohort study included 127 consecutive AHF patients. LUS on 28 antorolateral chest wall segment was done double blindly before discharging the patient to calculate the B-line. Clinical data, Composite Congestion Score (CCS) and echocardiography were collected. Cox proportional hazard regression analysis was performed to assess the independent predictor of rehabilitation or mortality during 120 days of observation. Results: The patients were 57.4 ± 7.8 years old, most were male (66.9%), with LV EF 36.7 ± 7.2%. The etiology of heart failure was caused by coronary heart disease (56.7%) and hypertensive heart disease (40.9%). The median number of B-lines was 24 (15 - 39). Hospitalization or death occurred in 43 patients (33.8%) during the median observation of 120 days (73-120). Patients with B-line pre-discharge ≥30 had a lower mean survival (log rank X2 48.14; p <0.001). In multivariate analysis, B-line pre-discharge ≥30 was the strongest independent predictor of rehabilitation or mortality (HR 4.71; 95% CI 2.15 - 10.32). Other independent predictors are Composite Congestion Score (CCS) ≥ 3 (HR 4.26; 95% CI 2.07 - 8.77) and NYHA functional class III (HR 2.87; 95% CI 1.49 - 5, 53). Conclusion: Persistent pulmonary congestion in AHF patients as assessed by B-line pre-discharge ≥30 is a strong independent predictor of rehospitalization or mortality. LUS could potentially help to guide the timing of discharge from AHF hospitalization, the follow-up scheduling and the therapy tailoring. Further randomized clinical studies are needed to definitely support the routine use of LUS.

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