Maria Chiara Scali1, Angela Zagatina2, Quirino Ciampi3, Lauro Cortigiani4, Antonello D'Andrea5, Clarissa Borguezan Daros6, Nadezhda Zhuravskaya2, Jaroslaw D Kasprzak7, Karina Wierzbowska-Drabik7, José Luis de Castro E Silva Pretto8, Ana Djordjevic-Dikic9, Branko Beleslin9, Marija Petrovic9, Nikola Boskovic9, Milorad Tesic9, Ines Monte10, Iana Simova11, Martina Vladova11, Alla Boshchenko12, Alexander Vrublevsky12, Rodolfo Citro13, Miguel Amor14, Paul E Vargas Mieles14, Rosina Arbucci15, Pablo Martin Merlo15, Diego M Lowenstein Haber15, Claudio Dodi16, Fausto Rigo17, Suzana Gligorova18, Milica Dekleva19, Sergio Severino20, Fabio Lattanzi1, Doralisa Morrone1, Maurizio Galderisi21, Marco A R Torres22, Alessandro Salustri23, Hugo Rodrìguez-Zanella24, Fabio Marco Costantino25, Albert Varga26, Gergely Agoston26, Eduardo Bossone27, Francesco Ferrara27, Nicola Gaibazzi28, Jelena Celutkiene29, Maciej Haberka30, Fabio Mori31, Maria Grazia D'Alfonso31, Barbara Reisenhofer32, Ana Cristina Camarozano33, Marcelo Haertel Miglioranza34, Ewa Szymczyk7, Paulina Wejner-Mik7, Katarzyna Wdowiak-Okrojek7, Tamara Preradovic-Kovacevic35, Tonino Bombardini35, Miodrag Ostojic36, Aleksandra Nikolic36, Federica Re37, Andrea Barbieri38, Giovanni Di Salvo39, Elisa Merli40, Paolo Colonna41, Valentina Lorenzoni42, Michele De Nes43, Marco Paterni43, Clara Carpeggiani43, Jorge Lowenstein15, Eugenio Picano44. 1. Cardiothoracic Department, University of Pisa, and Nottola Cardiology Division, Montepulciano, Siena, Italy. 2. Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg, Russian Federation. 3. Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy. 4. Cardiology Department, San Luca Hospital, Lucca, Italy. 5. Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy. 6. Cardiology Division, Hospital San José, Criciuma, Brasil. 7. Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland. 8. Hospital Sao Vicente de Paulo e Hospital de Cidade, Passo Fundo, Brasil. 9. Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia. 10. Cardio-Thorax-Vascular Department, Echocardiography lab, "Policlinico Vittorio Emanuele", Catania University, Catania, Italy. 11. Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria. 12. Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation. 13. Cardiology Department and Echocardiography Lab, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. 14. Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina. 15. Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina. 16. Casa di Cura Figlie di San Camillo, Cremona, Italy. 17. Cardiology Department, Ospedale dell'Angelo Mestre-Venice, Venice, Italy. 18. Cardiology Division Ospedale Casilino, Roma, Italy. 19. Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade, Serbia. 20. Cardiology Department, Coronary Care Unit, Monaldi Hospital, Second University of Naples, Naples, Italy. 21. Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy. 22. Hospital de Clinicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 23. Non-invasive Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. 24. Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico. 25. Cardiology Department, San Carlo Hospital, Potenza, Italy. 26. Institute of Family Medicine, University of Szeged, Szeged, Hungary. 27. Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy. 28. Cardiology Department, Parma University Hospital, Parma, Italy. 29. Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 30. Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland. 31. SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy. 32. Cardiology Division, Pontedera-Volterra Hospital, ASL Toscana Nord-Ovest, Italy. 33. Hospital de Clinicas UFPR, Medicine Department, Federal University of Paranà, Curitiba, Brazil. 34. Institute of Cardiology / University Foundation of Cardiology, Porto Alegre, Brazil. 35. School of Medicine, University Clinical Center of The Republic of Srpska, Banja-Luka, Bosnia-Herzegovina. 36. School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia. 37. Ospedale San Camillo, Cardiology Division, Rome, Italy. 38. Cardiology Division, Policlinico University Hospital of Modena, Modena, Italy. 39. Pediatric Cardiology Department, Cardiology Division, Brompton Hospital, Imperial College of London, London, United Kingdom. 40. Department of Cardiology, Ospedale per gli Infermi, Faenza, Ravenna, Italy. 41. Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy. 42. Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy. 43. CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy. 44. CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy. Electronic address: picano@ifc.cnr.it.
Abstract
OBJECTIVES: The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). BACKGROUND: B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. METHODS: The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. RESULTS: According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. CONCLUSIONS: Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020-The International Stress Echo Study [SE2020]; NCT03049995).
OBJECTIVES: The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). BACKGROUND: B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. METHODS: The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. RESULTS: According to B-lines at peak stresspatients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. CONCLUSIONS: Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020-The International Stress Echo Study [SE2020]; NCT03049995).
Authors: Eugenio Picano; Quirino Ciampi; Lauro Cortigiani; Adelaide M Arruda-Olson; Clarissa Borguezan-Daros; José Luis de Castro E Silva Pretto; Rosangela Cocchia; Eduardo Bossone; Elisa Merli; Garvan C Kane; Albert Varga; Gergely Agoston; Maria Chiara Scali; Doralisa Morrone; Iana Simova; Martina Samardjieva; Alla Boshchenko; Tamara Ryabova; Alexander Vrublevsky; Attila Palinkas; Eszter D Palinkas; Robert Sepp; Marco A R Torres; Hector R Villarraga; Tamara Kovačević Preradović; Rodolfo Citro; Miguel Amor; Hugo Mosto; Michael Salamè; Paul Leeson; Cristina Mangia; Nicola Gaibazzi; Domenico Tuttolomondo; Costantina Prota; Jesus Peteiro; Caroline M Van De Heyning; Antonello D'Andrea; Fausto Rigo; Aleksandra Nikolic; Miodrag Ostojic; Jorge Lowenstein; Rosina Arbucci; Diego M Lowenstein Haber; Pablo M Merlo; Karina Wierzbowska-Drabik; Jaroslaw D Kasprzak; Maciej Haberka; Ana Cristina Camarozano; Nithima Ratanasit; Fabio Mori; Maria Grazia D'Alfonso; Luigi Tassetti; Alessandra Milazzo; Iacopo Olivotto; Alberto Marchi; Hugo Rodriguez-Zanella; Angela Zagatina; Ratnasari Padang; Milica Dekleva; Ana Djordievic-Dikic; Nikola Boskovic; Milorad Tesic; Vojislav Giga; Branko Beleslin; Giovanni Di Salvo; Valentina Lorenzoni; Matteo Cameli; Giulia Elena Mandoli; Tonino Bombardini; Pio Caso; Jelena Celutkiene; Andrea Barbieri; Giovanni Benfari; Ylenia Bartolacelli; Alessandro Malagoli; Francesca Bursi; Francesca Mantovani; Bruno Villari; Antonello Russo; Michele De Nes; Clara Carpeggiani; Ines Monte; Federica Re; Carlos Cotrim; Giuseppe Bilardo; Ariel K Saad; Arnas Karuzas; Dovydas Matuliauskas; Paolo Colonna; Francesco Antonini-Canterin; Mauro Pepi; Patricia A Pellikka Journal: J Clin Med Date: 2021-08-17 Impact factor: 4.964
Authors: Hugo Rodriguez-Zanella; Rosina Arbucci; Juan Francisco Fritche-Salazar; Xochitl Arely Ortiz-Leon; Domenico Tuttolomondo; Diego Haber Lowenstein; Karina Wierzbowska-Drabik; Quirino Ciampi; Jarosław D Kasprzak; Nicola Gaibazzi; Jorge Lowenstein; Edith Liliana Posada-Martinez; Jose Antonio Arias-Godinez; Juan C de la Fuente-Mancera; Eugenio Picano Journal: J Clin Med Date: 2022-01-28 Impact factor: 4.241
Authors: Carlos Alberto Cotrim; Hugo Café; Isabel João; Nuno Cotrim; Jorge Guardado; Pedro Cordeiro; Hortense Cotrim; Luis Baquero Journal: World J Cardiol Date: 2022-02-26
Authors: Blanka Morvai-Illés; Nóra Polestyuk-Németh; István Adorján Szabó; Magdolna Monoki; Luna Gargani; Eugenio Picano; Albert Varga; Gergely Ágoston Journal: Front Cardiovasc Med Date: 2021-12-02