Masatake Kobayashi1, Masataka Watanabe2, Stefano Coiro3, Matthieu Bercker4, Yuki Paku2, Yoichi Iwasaki2, Taishiro Chikamori2, Akira Yamashina2, Kevin Duarte5, João Pedro Ferreira6, Patrick Rossignol6, Faiez Zannad6, Nicolas Girerd7. 1. Department of Cardiology, Tokyo Medical University, Tokyo, Japan; Université de Lorraine, INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm U1116, Nancy, France; INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France. 2. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 3. Division of Cardiology, University of Perugia, School of Medicine, Via S. Andrea delle fratte, Perugia, Italy. 4. Department de Cardiologie, CHU de Nancy, Institut Lorrain du coeur et des vaisseaux, Nancy, France. 5. Université de Lorraine, INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm U1116, Nancy, France; INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France. 6. Université de Lorraine, INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm U1116, Nancy, France; Department de Cardiologie, CHU de Nancy, Institut Lorrain du coeur et des vaisseaux, Nancy, France; INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France. 7. Université de Lorraine, INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm U1116, Nancy, France; Department de Cardiologie, CHU de Nancy, Institut Lorrain du coeur et des vaisseaux, Nancy, France; INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France. Electronic address: n.girerd@chru-nancy.fr.
Abstract
AIMS: Pulmonary congestion is associated with poor prognosis following hospitalization for worsening heart failure (HF), although its quantification and optimal timing during HF hospitalization remains challenging. The aim of this study was to assess the prognostic value of radiographic pulmonary congestion at admission and discharge in patients with worsening HF. METHODS AND RESULTS: Clinical, echocardiographic, laboratory and chest X-ray data of 292 acute decompensated HF patients were retrospectively studied (follow-up 1 year). Lung congestion was blindly scored on chest X-ray performed at admission and discharge using a systematic 6-zone approach. Primary clinical outcome was a composite outcome of re-hospitalization for worsening HF or all cause death. Patients were stratified according to the median of congestion score index (CSI) at both admission (median CSI(A) = 1.33) and discharge (median CSI(D) = 0.33). BNP levels, LVEF and eGFR did not differ between CSI categories. In multivariable Cox regression analysis, discharge CSI (HR for 1-point increase = 1.83 [1.02 to 3.27] p = 0.04) and discharge BNP were significantly associated with the composite outcome whereas NYHA class, physical signs, admission CSI and echocardiographic data were not. Furthermore, discharge CSI significantly increased reclassification on top of clinical covariates (continuous NRI = 19.6% [4.0 to 30.0] p = 0.03 and IDI = 2.2% [0.0 to 7.6] p = 0.046) while discharge BNP did not significantly improve risk reclassification. CONCLUSIONS: Residual pulmonary congestion assessed by radiographic scoring predicts poor prognosis beyond physical assessment, echocardiographic parameters and BNP. These findings further support the capital prognostic value of radiographic pulmonary congestion in patients hospitalized for worsening HF.
AIMS: Pulmonary congestion is associated with poor prognosis following hospitalization for worsening heart failure (HF), although its quantification and optimal timing during HF hospitalization remains challenging. The aim of this study was to assess the prognostic value of radiographic pulmonary congestion at admission and discharge in patients with worsening HF. METHODS AND RESULTS: Clinical, echocardiographic, laboratory and chest X-ray data of 292 acute decompensated HF patients were retrospectively studied (follow-up 1 year). Lung congestion was blindly scored on chest X-ray performed at admission and discharge using a systematic 6-zone approach. Primary clinical outcome was a composite outcome of re-hospitalization for worsening HF or all cause death. Patients were stratified according to the median of congestion score index (CSI) at both admission (median CSI(A) = 1.33) and discharge (median CSI(D) = 0.33). BNP levels, LVEF and eGFR did not differ between CSI categories. In multivariable Cox regression analysis, discharge CSI (HR for 1-point increase = 1.83 [1.02 to 3.27] p = 0.04) and discharge BNP were significantly associated with the composite outcome whereas NYHA class, physical signs, admission CSI and echocardiographic data were not. Furthermore, discharge CSI significantly increased reclassification on top of clinical covariates (continuous NRI = 19.6% [4.0 to 30.0] p = 0.03 and IDI = 2.2% [0.0 to 7.6] p = 0.046) while discharge BNP did not significantly improve risk reclassification. CONCLUSIONS: Residual pulmonary congestion assessed by radiographic scoring predicts poor prognosis beyond physical assessment, echocardiographic parameters and BNP. These findings further support the capital prognostic value of radiographic pulmonary congestion in patients hospitalized for worsening HF.
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: Masatake Kobayashi; Luna Gargani; Alberto Palazzuoli; Giuseppe Ambrosio; Antoni Bayés-Genis; Josep Lupon; Pierpaolo Pellicori; Nicola Riccardo Pugliese; Yogesh N V Reddy; Gaetano Ruocco; Kevin Duarte; Olivier Huttin; Patrick Rossignol; Stefano Coiro; Nicolas Girerd Journal: Clin Res Cardiol Date: 2020-08-08 Impact factor: 5.460
Authors: Daniel Pan; Pierpaolo Pellicori; Karen Dobbs; Jeanne Bulemfu; Ioanna Sokoreli; Alessia Urbinati; Oliver Brown; Shirley Sze; Alan S Rigby; Syed Kazmi; Jarno M Riistama; John G F Cleland; Andrew L Clark Journal: Clin Res Cardiol Date: 2021-03-22 Impact factor: 5.460