title: Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure.
abstract: OBJECTIVE
  Residual pulmonary congestion at discharge is associated with poor prognosis in heart failure (HF), but its quantification through physical examination is challenging. Ultrasound imaging of lung comets (B-lines) could improve congestion evaluation. The aim of this study was to assess the short-term prognostic value of B-lines after discharge from HF hospitalisation compared with other indices of haemodynamic congestion (BNP, E/e', and inferior vena cava diameter) or clinical status (NYHA class).
  
  
  RESULTS
  Sixty consecutive HF inpatients underwent clinical examination, echocardiography, and lung ultrasound at discharge, independently of, and in addition to routine management by the attending physicians. The median B-line count was 8.5 (5-34). Three-month event-free survival for the primary endpoint (all-cause death or HF hospitalisation) was 27 ± 10% in patients with ≥30 B-lines and 88 ± 5% in those with <30 B-lines (P < 0.0001). In a multivariable model, ≥30 B-lines significantly predicted the combined endpoint (hazard ratio 5.66, 95% confidence interval 1.74-18.39, P = 0.04), along with NYHA ≥III and inferior vena cava diameter, while other indirect measures of congestion (BNP and E/e' ≥15) were not retained in the model; furthermore ≥30 B-lines independently also predicted the secondary outcomes (HF hospitalisation and death). Importantly, B-line addition to NYHA class and BNP was associated with improved risk classification (integrated discrimination improvement 15%, P = 0.02; continuous net reclassification improvement 65%, P = 0.03).
  
  
  CONCLUSIONS
  Residual pulmonary congestion at discharge, as assessed by a B-line count ≥30, is a strong predictor of outcome. Lung ultrasonography may represent a useful tool to identify and monitor congestion and optimize therapy during and/or after hospitalisation for HF, which should be further validated in multicentre studies.
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.|INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors.forename: Stefano
authors.initials: S
authors.lastname: Coiro
authors.affiliation: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Erberto
authors.initials: E
authors.lastname: Carluccio
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Alunni
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Murrone
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Tritto
authors.affiliation: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D019468:Disease Management; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011654:Pulmonary Edema / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: B-lines; Chest ultrasound; Heart failure; Lung ultrasound; Pulmonary congestion