Point-of-care lung ultrasound predicts in-hospital mortality in acute heart failure

QJM ◽  
2020 ◽  
Author(s):  
D Araiza-Garaygordobil ◽  
R Gopar-Nieto ◽  
P Martínez-Amezcua ◽  
A Cabello-López ◽  
D Manzur-Sandoval ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Lung Ultrasound ◽  
Cox Regression ◽  
Point Of Care ◽  
Area Under The Curve ◽  
Optimal Receiver ◽  
Patients With Heart Failure ◽  
Incremental Prognostic Value ◽  
B Lines

Summary Background B-lines have been associated with adverse clinical outcomes in patients with heart failure (HF) when found at hospital discharge or during outpatient visits. Whether lung ultrasound (LUS) assessed B-lines may predict in-hospital mortality in patients with acute HF is still undetermined. Aim To evaluate the association between B-lines on admission and in-hospital mortality among patients admitted with acute HF. Methods Hand-held LUS was used to examine patients with acute HF. LUS was performed in eight chest zones with a pocket ultrasound device and analyzed offline. The association between B-lines and in-hospital mortality was assessed using Cox regression models. Results We included 62 patients with median age 56 years, 69.4% men, and median left ventricle ejection fraction 25%. The sum of B-lines ranged from 0 to 53 (median 6.5). An optimal receiver operating characteristic-determined cut-off of ≥19 B-lines demonstrated a sensitivity of 57% and a specificity of 86% (area under the curve 0.788) for in-hospital mortality. The incremental prognostic value of LUS when compared with lung crackles or peripheral edema by integrated discrimination improvement was 12.96% (95% CI: 7.0–18.8, P = 0.02). Patients with ≥19 B-lines had a 4-fold higher risk of in-hospital mortality (HR 4.38; 95% CI: 1.37–13.95, P < 0.01). Conclusion In patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality.

scholarly journals H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction

2020 ◽  
pp. postgradmedj-2019-137434
Author(s):  
Yifei Tao ◽  
Wenjing Wang ◽  
Jing Zhu ◽  
Tao You ◽  
Yi Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Support Vector ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Non Invasive ◽  
Patients With Heart Failure

BackgroundHeart failure with preserved ejection fraction (HFpEF) has received widespread attention in recent years. There is currently a lack of valuable predictors for the prognosis of this disease. Here, we aimed to identify a non-invasive scoring system that can effectively predict 1-year rehospitalisation for patients with HFpEF.MethodsWe included 151 consecutive patients with HFpEF in a prospective cohort study and investigated the association between H2FPEF score and 1-year readmission for heart failure using multivariate Cox regression analysis.ResultsOur findings indicated that obesity, age >70 years, treatment with ≥2 antihypertensives, echocardiographic E/e’ ratio >9 and pulmonary artery pressure >35 mm Hg were independent predictors of 1-year readmission. Three models (support vector machine, decision tree in R and Cox regression analysis) proved that H2FPEF score could effectively predict 1-year readmission for patients with HFpEF (area under the curve, 0.910, 0.899 and 0.771, respectively; p<0.001).ConclusionOur study demonstrates that the H2FPEF score has excellent predictive value for 1-year rehospitalisation of patients with HFpEF.

scholarly journals Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

2020 ◽  
Author(s):  
Anna M Maw ◽  
Carolina Ortiz-lopez ◽  
Megan A Morris ◽  
Christine Jones ◽  
Elaine Gee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Structured Interviews ◽  
Patients With Heart Failure ◽  
The Us ◽  
Time Required

AbstractAcute decompensated heart failure is the leading admitting diagnosis in patients 65 and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in 5 geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.

scholarly journals Pulmonary congestion by lung ultrasound in decompensated heart failure: associations, in-hospital changes, prognostic value

Kardiologiia ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 5-14 ◽  
Author(s):  
Zh. D. Kobalava ◽  
A. F. Safarova ◽  
A. E. Soloveva ◽  
F.E. Cabello ◽  
I. A. Meray ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Decompensated Heart Failure ◽  
Functional Class ◽  
Pulmonary Congestion ◽  
Cox Regression Analysis ◽  
History Of ◽  
B Lines

Background. Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF).Objective: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients.Materials and methods. Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively.Results. Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003).Conclusion. During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.

scholarly journals Lung Ultrasound Eight-Point Method in Diagnosing Acute Heart Failure in Emergency Patients with Acute Dyspnea: Diagnostic Accuracy and 72 h Monitoring

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 379
Author(s):  
Erika Glöckner ◽  
Felicitas Wening ◽  
Michael Christ ◽  
Alexander Dechêne ◽  
Katrin Singler
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Rating Scale ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Acute Dyspnea ◽  
Ultrasound Evaluation ◽  
B Lines

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.

scholarly journals LO074: Point of care ultrasound for lung B-lines in the early diagnosis of acute decompensated heart failure in the emergency department: a systematic review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S55-S55
Author(s):  
K. McGivery ◽  
P.R. Atkinson ◽  
D. Lewis ◽  
L. Taylor ◽  
K. Gadd
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Emergency Department ◽  
Likelihood Ratio ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Point Of Care Ultrasound ◽  
B Lines

Introduction: Dyspnea is a common presenting problem in the emergency department (ED) that frequently creates a diagnostic challenge for physicians. Acute decompensated heart failure (ADHF) represents a common cause that requires prompt diagnosis and management. Recent studies on dyspneic patients have suggested a potential role for point-of-care ultrasound (PoCUS). The objective of this systematic review was to assess the sensitivity and specificity of early bedside lung ultrasound in patients presenting to the ED with dyspnea. Methods: A search of the literature was conducted using PubMed, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conferences. We included prospective studies that assessed the diagnostic accuracy of B-lines from bedside lung ultrasound in the ED patients compared to a clinical diagnosis of ADHF at hospital discharge. The final diagnosis included at least one of CXR, computed tomography, or BNP. Two reviewers independently screened all titles and abstracts for possible inclusions. Two separate content experts full text-reviewed selected studies and performed quality analysis using a modified Critical Appraisal Skills Program (CASP) questionnaire. Extracted data was assessed with summary receiver operator characteristics curve (SROC) analysis with pooled sensitivity and specificity. Heterogenity was tested. Results: The electronic search yielded 3674 articles of which six met the inclusion criteria and fulfilled CASP requirements for methodological quality. The total number of patients in these studies was 1911. Heterogeneity was noted; due to poorer performance by novice users. Meta-analysis of the data showed that in detecting ADHF, bedside lung ultrasound had a pooled sensitivity of 89.6% (95% CI 69.5 to 97.0%) and a pooled specificity of 88.4% (95% CI 75.0 to 95.1%). The positive likelihood ratio was 6.01 (95% CI 2.93 to 12.32) and negative likelihood ratio was 0.13 (95% CI 0.06 to 0.30). Conclusion: This study suggests that in patients presenting to the ED with undifferentiated dyspnea, early point of care lung ultrasound may be used to confirm the diagnosis of ADHF, which may facilitate earlier appropriate management. Test performance may vary according to experience.

scholarly journals Ability of non-physicians to perform and interpret lung ultrasound: A systematic review

2019 ◽  
Vol 18 (6) ◽  
pp. 474-483 ◽  
Author(s):  
Varsha Swamy ◽  
Philip Brainin ◽  
Tor Biering-Sørensen ◽  
Elke Platz
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Ultrasound Images ◽  
Pulmonary Congestion ◽  
Pleural Effusions ◽  
Brief Training ◽  
Online Databases ◽  
B Lines

Background: Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. Aims: To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. Methods and results: We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0–12 h of didactic training and 58–62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79–98% and a specificity of 70–99%. In image adequacy studies, medical students with 2–9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50–100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. Conclusions: Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.

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

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.

Abstract 14922: Prognostic Value of Baseline BNP and NT-ProBNP and its Interaction With Spironolactone in Patients With Heart Failure and Preserved Ejection Fraction in the TOPCAT Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Inder S Anand ◽  
Scott D Solomon ◽  
Brian Claggett ◽  
Sanjiv J Shah ◽  
Eileen O’Meara ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Cox Regression ◽  
Selection Criterion ◽  
Adverse Outcomes ◽  
Preserved Ejection Fraction ◽  
Patient Selection Criterion ◽  
Increased Risk ◽  
Patients With Heart Failure

Background: Plasma natriuretic peptides (NP) are helpful in the diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) and predict adverse outcomes. Levels of NP beyond a certain cut-off level are often used as inclusion criteria in clinical trials to ensure that the patients have HF, and to select patients at higher risk. Whether treatments have a differential effect on outcomes across the spectrum of NP levels is unclear. In the I-Preserve trial a benefit of irbesartan on all outcomes was only seen in HFpEF patients with low but not high NP levels. We hypothesized that in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, spironolactone might have a greater benefit in patients with lower NP levels. Methods and Results: BNP (n=468) or NT-proBNP (n=400) levels were available at baseline in 868 patients with HFpEF enrolled in the natriuretic peptide stratum (BNP ≥100 pg/mL or an NT- proBNP ≥360 pg/mL) of the TOPCAT trial. In a multi-variable Cox regression model, that included age, gender, region (Americas vs. Russia/Georgia), atrial fibrillation, diabetes, eGFR, BMI and heart rate, higher BNP or NT-proBNP as a continuous, standardized log-transformed variable or grouped by terciles (see Figure for BNP & NT-proBNP tercile values) was independently associated with an increased risk of the primary endpoint of cardiovascular mortality, aborted cardiac arrest, or hospitalization for heart failure (Figure-1). There was a significant interaction between the effect of spironolactone and baseline BNP or NT-proBNP terciles for the primary outcome (P=0.02, Figure-2), with greater benefit of the drug in the lower compared to higher NP terciles. Conclusions: The benefit of spironolactone in lower risk HFpEF patients may indicate effects of the drug on early, but not late higher-risk stage of the disease. These findings question the strategy of using elevated NP as a patient selection criterion in HFpEF trials.

scholarly journals Evaluation of independent predictors of in-hospital mortality in patients with severe trauma

2019 ◽  
Vol 147 (7-8) ◽  
pp. 455-460
Author(s):  
Marija Milenkovic ◽  
Zaneta Terzioski ◽  
Adi Hadzibegovic ◽  
Jovana Stanisavljevic ◽  
Ksenija Petrovic ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cox Regression ◽  
Arterial Oxygen Saturation ◽  
Area Under The Curve ◽  
Case Fatality ◽  
Scoring Systems ◽  
Severe Trauma ◽  
Arterial Oxygen ◽  
Emergency Center ◽  
Cox Regression Analysis

Introduction/Objective. The aim of this study was to determine independent predictors and the best trauma scoring system (REMS, RTS, GSC, SOFA, APPACHE II) of in-hospital mortality in patients with severe trauma at the Department of Emergency, Emergency Center, Clinical Center of Serbia, Belgrade. Methods. Longitudinal study included 208 consecutive patients with severe trauma. In order to determine independent survival contributors, univariate and multivariate Cox regression analyses were performed. The power of above-mentioned scoring systems (measured at admission to the Emergency center) to predict mortality was compared using the area under the curve (AUC). Results. There were 208 patients (159 male, 49 female), with the average age of 47.3 ? 20.7 years. Majority of patients were initially intubated (86.1%) on admission to the emergency department, and 59.6% patients were sedated before intubation. After finishing of diagnostic procedures, 17 patients were additionally intubated, and, at that time, 94.2% patients were on mechanic ventilation. The majority of patients was traumatized in a car crash (33.2%), followed by falls from height (26.4%) and as pedestrians (22.6%). Patients had an average of 24.7 ? 21.2 days spent in intensive care unit. The overall case-fatality ratio was 17/208 (8.2%). In Cox regression analysis only elevated heart rate (HR = 1.03, p = 0.012) and decreased arterial oxygen saturation (SpO2) (HR = 0.91, p = 0.033) singled out as independent contributors to in-hospital mortality of patients with severe trauma. REMS (AUC 0.72 ? 0.64) and SOFA (AUC 0.716 ? 0.067) scores were found fair and similar predictor of in-hospital mortality, while APACHE II (AUC 0.614 ? 0.062) and RTS (0.396 ? 0.068) were poor predictors. Conclusion. Results of this study showed an important role of REMS, which appears to provide balance between the predictive ability and the practical application, and components of REMS in prediction of outcome in patients with severe trauma and that HR and SpO2 are independent predictors of in-hospital mortality.

scholarly journals Lung Ultrasound B-lines as a Surrogate Marker for High Left Ventricular Diastolic Pressures; a bed-side Diagnostic tool

2021 ◽  
Vol 4 (18) ◽  
pp. 01-11
Author(s):  
Abdulaziz Aboshahba ◽  
Alsayed Ali Abdou Almarghany ◽  
Moaz Atef Elshahat Abdel ati
Keyword(s):  
Heart Failure ◽  
Cost Efficiency ◽  
Lung Ultrasound ◽  
Surrogate Marker ◽  
Left Ventricular ◽  
University Hospital ◽  
Emergency Setting ◽  
Comet Tail ◽  
Chest Ultrasound ◽  
B Lines

Background: We studied the diagnostic accuracy of B-lines (comet-tail sign) on bedside lung US, NT-proBNP, E/e` on ECHO in differentiation of the causes of acute dyspnea in the emergency setting. Major advantages include bedside availability, no radiation, high feasibility and reproducibility, and cost efficiency. Methods: Our prospective study was performed at the alazhar university hospital, Cairo, Egypt, between July 2019 and March 2020. All patients underwent lung ultrasound examinations, along with TTE, laboratory testing, including rapid NT-proBNP testing. Results: The median E/e’ levels in patients with B-profile were 18, compared with a median of 7.4 in the subjects with A-profile (P =< 0.0001 CI = -9.649 to -7.044). It was found that the sensitivity and the specificity of detecting B-profile on ultrasound is high when E/e’ > 15.5 (95.0% and 83.0% consecutively), which concluded the high correlation between finding B profile on U/S chest and elevated left ventricle filling pressure in a patient presenting with picture of suggestive of heart failure Conclusion: Chest ultrasound can be used as screening test for the evaluation of patients with suspicion of heart failure with excellent sensitivity and good specificity.

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