Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study.
BACKGROUND
B-lines evaluated by lung ultrasound (LUS) are the sonographic sign of pulmonary congestion, a major predictor of morbidity and mortality in patients with heart failure (HF). Our aim was to assess the prognostic value of B-lines at discharge to predict rehospitalization at 6 months in patients with acute HF (AHF).


METHODS
A prospective cohort of 100 patients admitted to a Cardiology Department for dyspnea and/or clinical suspicion of AHF were enrolled (mean age 70 ± 11 years). B-lines were evaluated at admission and before discharge. Subjects were followed-up for 6-months after discharge.


RESULTS
Mean B-lines at admission was 48 ± 48 with a statistically significant reduction before discharge (20 ± 23, p < .0001). During follow-up, 14 patients were rehospitalized for decompensated HF. The 6-month event-free survival was highest in patients with less B-lines (≤ 15) and lowest in patients with more B-lines (> 15) (log rank χ(2) 20.5, p < .0001). On multivariable analysis, B-lines > 15 before discharge (hazard ratio [HR] 11.74; 95 % confidence interval [CI] 1.30-106.16) was an independent predictor of events at 6 months.


CONCLUSIONS
Persistent pulmonary congestion before discharge evaluated by ultrasound strongly predicts rehospitalization for HF at 6-months. Absence or a mild degree of B-lines identify a subgroup at extremely low risk to be readmitted for HF decompensation.
National Research Council of Pisa, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy. gargani@ifc.cnr.it.
Luna
L
Gargani
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA.
P S
PS
Pang
Department of Emergency Medicine, Azienda Ospedaliero-Universitaria, Pisa, Italy.
F
F
Frassi
Cardiology of Rio Grande do Sul, Porto Alegre, Brazil.
M H
MH
Miglioranza
Cardiac, Vascular and Thoracic Department, Azienda Ospedaliero-Universitaria, Pisa, Italy.
F L
FL
Dini
National Research Council of Pisa, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy.
P
P
Landi
National Research Council of Pisa, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy.
E
E
Picano
D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D011654:Pulmonary Edema / Q000453:epidemiology* / Q000401:mortality*; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014463:Ultrasonography / Q000706:statistics & numerical data