Elke Platz1, Ross T Campbell2, Brian Claggett3, Eldrin F Lewis3, John D Groarke3, Kieran F Docherty2, Matthew M Y Lee2, Allison A Merz4, Montane Silverman4, Varsha Swamy4, Moritz Lindner4, Jose Rivero3, Scott D Solomon3, John J V McMurray2. 1. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: eplatz@bwh.harvard.edu. 2. British Heart Foundation (BHF) Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. 3. Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. 4. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Abstract
OBJECTIVES: This study sought to assess the prevalence, changes in, and prognostic importance of B-lines, a pulmonary congestion measure by using a simplified lung ultrasonography (LUS) method in acute heart failure (AHF). BACKGROUND: Pulmonary congestion is an important finding in AHF, but conventional methods for its detection are insensitive. METHODS: In a 2-site, prospective, observational study, 4-zone LUS was performed early during hospitalization for AHF (LUS1) and at discharge (LUS2). B-lines were quantified off-line, blinded to clinical findings and outcomes, by a core laboratory. RESULTS: Among 349 patients (median, 75 years of age; 59% men; mean ejection fraction 39%), the sum of B-lines in 4 zones ranged from 0 to 18 (LUS1). The risk of an adverse in-hospital event increased with rising number of B-lines on LUS1: the odds ratio for each B-line tertile was 1.82 (95% confidence interval [CI]: 1.14 to 2.88; p = 0.011). B-line count decreased from a median of 6 (LUS1) to 4 (LUS2; p < 0.001) over 6 days (median). In 132 patients with LUS2 images, the risk of HF hospitalization or all-cause death was greater in patients with a higher number of B-lines at discharge. This relationship was stronger closer to discharge: unadjusted hazard ratio (HR) at 60 days was 3.30 (95% CI: 1.52 to 7.17; p = 0.002); 2.94 at 90 days (95% CI: 1.46 to 5.93; p = 0.003); and 2.01 at 180 days (95% CI: 1.11 to 3.64; p = 0.021). The association between number of B-lines and short- and long-term outcomes persisted after adjusting for important clinical variables, including N-terminal pro-B-type natriuretic peptide. CONCLUSIONS: Pulmonary congestion using a simplified 4-zone LUS method was common in patients with AHF and improved with therapy. A higher number of B-lines at baseline and discharge identified patients at increased risk for adverse events.
OBJECTIVES: This study sought to assess the prevalence, changes in, and prognostic importance of B-lines, a pulmonary congestion measure by using a simplified lung ultrasonography (LUS) method in acute heart failure (AHF). BACKGROUND:Pulmonary congestion is an important finding in AHF, but conventional methods for its detection are insensitive. METHODS: In a 2-site, prospective, observational study, 4-zone LUS was performed early during hospitalization for AHF (LUS1) and at discharge (LUS2). B-lines were quantified off-line, blinded to clinical findings and outcomes, by a core laboratory. RESULTS: Among 349 patients (median, 75 years of age; 59% men; mean ejection fraction 39%), the sum of B-lines in 4 zones ranged from 0 to 18 (LUS1). The risk of an adverse in-hospital event increased with rising number of B-lines on LUS1: the odds ratio for each B-line tertile was 1.82 (95% confidence interval [CI]: 1.14 to 2.88; p = 0.011). B-line count decreased from a median of 6 (LUS1) to 4 (LUS2; p < 0.001) over 6 days (median). In 132 patients with LUS2 images, the risk of HF hospitalization or all-cause death was greater in patients with a higher number of B-lines at discharge. This relationship was stronger closer to discharge: unadjusted hazard ratio (HR) at 60 days was 3.30 (95% CI: 1.52 to 7.17; p = 0.002); 2.94 at 90 days (95% CI: 1.46 to 5.93; p = 0.003); and 2.01 at 180 days (95% CI: 1.11 to 3.64; p = 0.021). The association between number of B-lines and short- and long-term outcomes persisted after adjusting for important clinical variables, including N-terminal pro-B-type natriuretic peptide. CONCLUSIONS:Pulmonary congestion using a simplified 4-zone LUS method was common in patients with AHF and improved with therapy. A higher number of B-lines at baseline and discharge identified patients at increased risk for adverse events.
Authors: Pierpaolo Pellicori; Elke Platz; Jeroen Dauw; Jozine M Ter Maaten; Pieter Martens; Emanuele Pivetta; John G F Cleland; John J V McMurray; Wilfried Mullens; Scott D Solomon; Faiez Zannad; Luna Gargani; Nicolas Girerd Journal: Eur J Heart Fail Date: 2020-11-23 Impact factor: 15.534
Authors: Caroline Espersen; Ross T Campbell; Brian Claggett; Eldrin F Lewis; John D Groarke; Kieran F Docherty; Matthew M Y Lee; Moritz Lindner; Tor Biering-Sørensen; Scott D Solomon; John J V McMurray; Elke Platz Journal: ESC Heart Fail Date: 2021-03-11
Authors: Moritz Lindner; Richard Thomas; Brian Claggett; Eldrin F Lewis; John Groarke; Allison A Merz; Montane B Silverman; Varsha Swamy; Jose Rivero; Christian Hohenstein; Scott D Solomon; John Jv McMurray; Michael L Steigner; Elke Platz Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-01-24
Authors: Øyvind Johannessen; Brian Claggett; Eldrin F Lewis; John D Groarke; Varsha Swamy; Moritz Lindner; Scott D Solomon; Elke Platz Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-10-27