OBJECTIVES: The aim of this study was to define the performance of lung ultrasound (LUS) compared with clinical assessment, natriuretic peptides, and echocardiography, to evaluate decompensation in patients with systolic heart failure (HF) in an outpatient clinic. BACKGROUND: Evaluation of pulmonary congestion in chronic HF is challenging. LUS has been recently proposed as a reliable tool for the semiquantification of extravascular lung water through assessment of B-lines. METHODS: This was a cohort study of patients with moderate to severe systolic HF. Receiver-operating characteristic (ROC) analyses were performed to compare LUS with a previously validated clinical congestion score (CCS), amino-terminal portion of B-type natriuretic peptide (NT-proBNP), E/e' ratio, chest x-ray, and 6-min walk test. RESULTS: Ninety-seven patients were enrolled. Decompensation was present in 57.7% of patients when estimated by CCS, 68% by LUS, 53.6% by NT-proBNP, and 65.3% by E/e' ≥15. The number of B-lines was correlated to NT-proBNP (r = 0.72; p < 0.0001), E/e' (r = 0.68; p < 0.0001), and CCS (r = 0.43; p < 0.0001). In ROC analyses, considering as reference for decompensation a combined method (E/e' ≥ 15 and/or NT-proBNP >1,000 pg/ml), LUS yielded a C-statistic of 0.89 (95% confidence interval: 0.82 to 0.96), providing the best accuracy with a cutoff ≥ 15 B-lines (sensitivity 85%, specificity 83%). A systematic approach using CCS, E/e', NT-proBNP, chest x-ray, and 6-min walk test in different combinations as reference for decompensation also corroborated this cutoff and found a similar accuracy for LUS. CONCLUSIONS: In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF.
OBJECTIVES: The aim of this study was to define the performance of lung ultrasound (LUS) compared with clinical assessment, natriuretic peptides, and echocardiography, to evaluate decompensation in patients with systolic heart failure (HF) in an outpatient clinic. BACKGROUND: Evaluation of pulmonary congestion in chronic HF is challenging. LUS has been recently proposed as a reliable tool for the semiquantification of extravascular lung water through assessment of B-lines. METHODS: This was a cohort study of patients with moderate to severe systolic HF. Receiver-operating characteristic (ROC) analyses were performed to compare LUS with a previously validated clinical congestion score (CCS), amino-terminal portion of B-type natriuretic peptide (NT-proBNP), E/e' ratio, chest x-ray, and 6-min walk test. RESULTS: Ninety-seven patients were enrolled. Decompensation was present in 57.7% of patients when estimated by CCS, 68% by LUS, 53.6% by NT-proBNP, and 65.3% by E/e' ≥15. The number of B-lines was correlated to NT-proBNP (r = 0.72; p < 0.0001), E/e' (r = 0.68; p < 0.0001), and CCS (r = 0.43; p < 0.0001). In ROC analyses, considering as reference for decompensation a combined method (E/e' ≥ 15 and/or NT-proBNP >1,000 pg/ml), LUS yielded a C-statistic of 0.89 (95% confidence interval: 0.82 to 0.96), providing the best accuracy with a cutoff ≥ 15 B-lines (sensitivity 85%, specificity 83%). A systematic approach using CCS, E/e', NT-proBNP, chest x-ray, and 6-min walk test in different combinations as reference for decompensation also corroborated this cutoff and found a similar accuracy for LUS. CONCLUSIONS: In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF.
Authors: Chiara Mozzini; Marco Di Dio Perna; Giancarlo Pesce; Ulisse Garbin; Anna Maria Fratta Pasini; Andrea Ticinesi; Antonio Nouvenne; Tiziana Meschi; Alder Casadei; Maurizio Soresi; Luciano Cominacini Journal: Intern Emerg Med Date: 2017-08-12 Impact factor: 3.397
Authors: Yogesh N V Reddy; Masaru Obokata; Brandon Wiley; Katlyn E Koepp; Caitlin C Jorgenson; Alexander Egbe; Vojtech Melenovsky; Rickey E Carter; Barry A Borlaug Journal: Eur Heart J Date: 2019-12-01 Impact factor: 29.983
Authors: Eva M Boorsma; Jozine M Ter Maaten; Kevin Damman; Wilfried Dinh; Finn Gustafsson; Steven Goldsmith; Daniel Burkhoff; Faiez Zannad; James E Udelson; Adriaan A Voors Journal: Nat Rev Cardiol Date: 2020-05-15 Impact factor: 32.419
Authors: Kristin H Dwyer; Allison A Merz; Eldrin F Lewis; Brian L Claggett; Daniela R Crousillat; Emily S Lau; Montane B Silverman; Julie Peck; Jose Rivero; Susan Cheng; Elke Platz Journal: J Card Fail Date: 2018-03-01 Impact factor: 5.712
Authors: Claudia Torino; Luna Gargani; Rosa Sicari; Krzysztof Letachowicz; Robert Ekart; Danilo Fliser; Adrian Covic; Kostas Siamopoulos; Aristeidis Stavroulopoulos; Ziad A Massy; Enrico Fiaccadori; Alberto Caiazza; Thomas Bachelet; Itzchak Slotki; Alberto Martinez-Castelao; Marie-Jeanne Coudert-Krier; Patrick Rossignol; Faikah Gueler; Thierry Hannedouche; Vincenzo Panichi; Andrzej Wiecek; Giuseppe Pontoriero; Pantelis Sarafidis; Marian Klinger; Radovan Hojs; Sarah Seiler-Mussler; Fabio Lizzi; Dimitrie Siriopol; Olga Balafa; Linda Shavit; Rocco Tripepi; Francesca Mallamaci; Giovanni Tripepi; Eugenio Picano; Gérard Michel London; Carmine Zoccali Journal: Clin J Am Soc Nephrol Date: 2016-09-22 Impact factor: 8.237