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Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF

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Abstract

Background

Lung ultrasound (LUS) can be used to assess pulmonary congestion by imaging B-lines (‘comets’) for patients with acute heart failure (AHF).

Objectives

Investigate relationship of B-lines, plasma concentrations of B-type natriuretic peptide (BNP), and echocardiographic left ventricular (LV) function measured at admission and discharge and their relationship to prognosis for AHF with preserved (HFpEF) or reduced (HFrEF) LV ejection fraction.

Methods

Patients with AHF had the above tests done at admission and discharge. The primary outcome was re-hospitalization for heart failure or death at 6 months.

Results

Of 162 patients enrolled, 95 had HFrEF and 67 had HFpEF, median age was 80 [77–85] years, and 85 (52%) were women. The number of B-lines at admission (median 31 [27–36]) correlated with respiratory rate (r = 0.75; p < 0.001), BNP (r = 0.43; p < 0.001), clinical congestion score (r = 0.25; p = 0.001), and systolic pulmonary artery pressure (r = 0.42; p < 0.001). At discharge, B-lines were also correlated with BNP (r = 0.69; p < 0.001) and congestion score (r = 0.57; p < 0.001). B-line count at discharge predicted outcome (AUC 0.83 [0.77–0.90]; univariate HR 1.12 [1.09–1.16]; p < 0.001; multivariable HR 1.16 [1.11–1.21]; p < 0.001). Results were similar for HFpEF and HFrEF.

Conclusions

LUS appears a useful method to assess severity and monitor the resolution of lung congestion. At hospital admission, B-lines are strongly related to respiratory rate, which may be a key component of the sensation of dyspnea. Measurement of lung congestion at discharge provides prognostic information for patients with either HFpEF or HFrEF.

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Abbreviations

AHF:

Acute heart failure

AF:

Atrial fibrillation

BNP:

B-type natriuretic peptide

DT:

Deceleration time

EF:

Ejection fraction

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

IVRT:

Isovolumetric relaxation time

LUS:

Lung ultrasound

LV:

Left ventricular

NP:

Natriuretic peptides

PAPs:

Systolic pulmonary artery pressure

ROC:

Receiving operating characteristics

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Authors and Affiliations

  1. Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Siena, Italy

    Alberto Palazzuoli, Gaetano Ruocco, Matteo Beltrami & Ranuccio Nuti

  2. National Heart and Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals, Imperial College, London, UK

    John G. Cleland

  3. Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK

    John G. Cleland

Authors
  1. Alberto Palazzuoli
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  2. Gaetano Ruocco
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  3. Matteo Beltrami
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  4. Ranuccio Nuti
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  5. John G. Cleland
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Contributions

AP and GR helped conceive and design the study and interpreted the results AP supervised the research and wrote the first draft of the manuscript. GR provided statistical analysis and revised the manuscript. MB helped acquire data. RN and JGC contributed to data interpretation and revision of the manuscript. All authors gave final approval of the version to be published.

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Correspondence to Alberto Palazzuoli.

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Conflict of interest

Dr. Palazzuoli, Ruocco, Beltrami, and Nuti report no relevant conflicts; Prof. J. G. Cleland has received research grants from Amgen, Novartis, and Stealth Biopharmaceuticals.

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Palazzuoli, A., Ruocco, G., Beltrami, M. et al. Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clin Res Cardiol 107, 586–596 (2018). https://doi.org/10.1007/s00392-018-1221-7

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