Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two centre cohort study
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.
Scientific reports