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Residual congestion and long-term prognosis in acutely decompensated heart failure patients

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Abstract

Aims

Recent studies have established the role of residual congestion evaluated by lung ultrasound in estimating short-term risk of readmission or death in patients admitted for heart failure (HF) decompensation. However, if lung ultrasounds maintain a prognostic role of in long-term survival is still unknown. Aim of our study was to evaluate if residual congestion could predict all-cause mortality during 4 year follow up in a cohort of unselected patients admitted for acute decompensated HF.

Methods

One-hundred fifty patients were enrolled. The anterolateral chest was scanned to evaluate the presence of B-lines. A sonographic score was calculated attributing 1 to each positive sector (≥ 3 B-lines). Clinical, biochemical and echocardiographic data were recorded. A Cox proportional hazard regression analysis was performed to evaluate the association between variables and 4-year survival.

Results

During the follow-up, 86 patients (58%) died. Univariate analysis showed a significant correlation between the sonographic score at discharge and events occurrence at long term follow up (HR 1.21; CI 1.11–1.31; p < 0.001) suggesting that, on average, the increase of 1 point in the sonographic score was associated with an increase of approximately 20% in the risk of death.

Conclusions

Our results suggest the role of LUS in the identification of more congested HF patients, that will be at risk for worse long term outcome.

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Author notes

  1. S. Furlotti

    Present address: Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Trieste, Italy

Authors and Affiliations

  1. Department of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy

    E. Ceriani, D. Torzillo, S. Furlotti & C. Cogliati

  2. Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy

    G. Casazza

  3. Department of Internal Medicine, Ca Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Via F.Sforza 35, Milan, Italy

    E. Ceriani & J. Peta

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  1. E. Ceriani
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  2. G. Casazza
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  4. D. Torzillo
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Contributions

EC: This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. GC: This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. JP: This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. DT: This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. SF: This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. CC: This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Correspondence to E. Ceriani.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Ceriani, E., Casazza, G., Peta, J. et al. Residual congestion and long-term prognosis in acutely decompensated heart failure patients. Intern Emerg Med 15, 719–724 (2020). https://doi.org/10.1007/s11739-020-02326-y

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