Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
Rivas-Lasarte, Mercedes ![ORCID Identifier](/img/uab/orcid.ico)
(Institut d'Investigació Biomèdica Sant Pau)
Maestro, Alba ![ORCID Identifier](/img/uab/orcid.ico)
(Institut d'Investigació Biomèdica Sant Pau)
Fernández-Martínez, Juan (Institut d'Investigació Biomèdica Sant Pau)
López-López, Laura ![ORCID Identifier](/img/uab/orcid.ico)
(Institut d'Investigació Biomèdica Sant Pau)
Solé González, Eduard ![ORCID Identifier](/img/uab/orcid.ico)
(Hospital del Mar (Barcelona, Catalunya))
Vives-Borrás, Miquel ![ORCID Identifier](/img/uab/orcid.ico)
(Institut d'Investigació Biomèdica Sant Pau)
Montero, Santiago
(Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Mesado, Nuria (Institut d'Investigació Biomèdica Sant Pau)
Pirla, Maria José (Institut d'Investigació Biomèdica Sant Pau)
Mirabet Pérez, Sonia
(Institut d'Investigació Biomèdica Sant Pau)
Fluvià, Paula
(Hospital Universitari de Girona Doctor Josep Trueta)
Brossa Loidi, Vicens
(Institut d'Investigació Biomèdica Sant Pau)
Sionis, Alessandro
(Institut d'Investigació Biomèdica Sant Pau)
Roig, Eulàlia
(Institut d'Investigació Biomèdica Sant Pau)
Cinca, Juan
(Institut d'Investigació Biomèdica Sant Pau)
Alvarez-Garcia, Jesus
(Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona
Date: |
2020 |
Abstract: |
Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in patients admitted for acute HF. This is a post-hoc analysis of the LUS-HF trial. LUS was performed by the investigators in eight chest zones with a pocket device. Physical exam was subsequently performed by the treating physicians. Primary outcome was a combined endpoint of rehospitalization, unexpected visit for HF worsening or death at 6- month follow-up. Subclinical pulmonary congestion at discharge was defined as the presence of ≥5 B-lines in LUS in absence of rales in the auscultation employing the area under the ROC curve. At discharge, 100 patients (81%) did not show clinical signs of pulmonary congestion. Of these, 41 had ≥5 B-lines. Independent factors related with the presence of subclinical pulmonary congestion were anaemia, higher New York Heart Association (NYHA) class, and N terminal pro brain natriuretic peptide (NT-proBNP). After adjusting by propensity score analysis including age, renal insufficiency, atrial fibrillation, NYHA class, NT-proBNP levels, clinical congestion, and the trial intervention, the presence of subclinical pulmonary congestion at discharge was a risk factor for the occurrence of the primary outcome (hazard ratio 2. 63; 95% confidence interval: 1. 08-6. 41; P = 0. 033). Up to 40% of patients considered 'dry' according to pulmonary auscultation presents subclinical congestion at hospital discharge that can be detected by LUS and implies a worse prognosis at 6- month follow-up. Comorbidities, high values of natriuretic peptides, and higher NYHA class are the factors related with its presence. |
Grants: |
Instituto de Salud Carlos III CM17-00028 Ministerio de Economía y Competitividad CB16-11-00276
|
Rights: |
Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. ![Creative Commons](/img/licenses/by-nc.ico) |
Language: |
Anglès |
Document: |
Article ; recerca ; Versió publicada |
Subject: |
Heart failure ;
Lung ultrasound ;
Pulmonary congestion ;
Prognosis |
Published in: |
ESC Heart Failure, Vol. 7 (july 2020) , p. 2621-2628, ISSN 2055-5822 |
DOI: 10.1002/ehf2.12842
PMID: 32633473
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Record created 2021-04-13, last modified 2024-07-31