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

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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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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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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Keywords

  • Lung ultrasound
  • Heart failure
  • Prognosis
  • B-lines