title: Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study.
abstract: Pulmonary congestion assessed at discharge by lung ultrasonography predicts poor prognosis in heart failure (HF) patients. We investigated the association of B-lines with indices of hemodynamic congestion [BNP, E/e', pulmonary systolic arterial pressure (PAPs)] in HF patients, and their prognostic value overall and according to concomitant atrial fibrillation (AF), reduced (≤40%) ejection fraction (EF), and timing of quantification during hospitalisation for heart failure (HHF). In 110 HHF patients, B-lines were highly discriminative of BNP >400 pg/ml (AUC ≥ 0.80 for all), and moderately discriminative of PAPs >50 mmHg (AUC = 0.68, 0.56 to 0.80); conversely, B-lines poorly discriminated average E/e' ≥ 15, except at discharge. B-line count significantly predicted mid-term recurrent HHF or death (overall and in subgroups), regardless of AF status, EF, and timing of quantification during HHF (all p for interaction >0.10). regardless, B-lines ≥30 at discharge were most predictive of outcome (HR = 7.11, 2.06-24.48; p = 0.002) while B-lines ≥45 early during HHF were most predictive of outcome (HR = 9.20, 1.82-46.61; p = 0.007). Lung ultrasound was able to identify patients with high BNP levels, but not with increased E/e', also showing a prognostic role regardless of AF status, EF or timing of quantification; best B-line cut-off appears to vary according to the timing of quantification during hospitalization.
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Via S. Andrea delle fratte, Perugia, Italy.|INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors.forename: Stefano
authors.initials: S
authors.lastname: Coiro
authors.affiliation: Departement de Cardiologie, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Porot
authors.affiliation: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, 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, Via S. Andrea delle fratte, Perugia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Via S. Andrea delle fratte, Perugia, Italy.
authors.forename: Erberto
authors.initials: E
authors.lastname: Carluccio
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Via S. Andrea delle fratte, Perugia, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Tritto
authors.affiliation: Departement de Cardiologie, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huttin
authors.affiliation: Departement de Cardiologie, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Lemoine
authors.affiliation: Departement de Cardiologie, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.affiliation: Département de Cardiologie &CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.|Departement de Cardiologie, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, 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, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.|Departement de Cardiologie, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
mesh_terms: D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D001281:Atrial Fibrillation / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000473:pathology*; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D014463:Ultrasonography / Q000379:methods