Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
Aims 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 patie...
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| Published in | ESC Heart Failure Vol. 7; no. 5; pp. 2621 - 2628 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
John Wiley & Sons, Inc
01.10.2020
John Wiley and Sons Inc Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2055-5822 2055-5822 |
| DOI | 10.1002/ehf2.12842 |
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| Abstract | Aims
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.
Methods and results
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).
Conclusions
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. |
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| AbstractList | 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. AimsResidual 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.Methods and resultsThis 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).ConclusionsUp 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. 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.AIMSResidual 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).METHODS AND RESULTSThis 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.CONCLUSIONSUp 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. Aims 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. Methods and results 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). Conclusions 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. Aims 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. Methods and results 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). Conclusions 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. Abstract Aims 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. Methods and results 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). Conclusions 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. |
| Author | López‐López, Laura Mesado, Nuria Álvarez‐García, Jesús Fluvià, Paula Rivas‐Lasarte, Mercedes Maestro, Alba Montero, Santiago Pirla, Maria J. Sionis, Alessandro Fernández‐Martínez, Juan Brossa, Vicens Solé‐González, Eduard Vives‐Borrás, Miquel Cinca, Juan Roig, Eulàlia Mirabet, Sonia |
| AuthorAffiliation | 1 Cardiology Department Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona Barcelona Spain 2 Cardiology Department Hospital del Mar Barcelona Spain 3 Cardiology Department Hospital Germans Trias i Pujol, Universitat Autónoma de Barcelona Barcelona Spain 4 Cardiology Department Hospital Doctor Josep Trueta Gerona Spain |
| AuthorAffiliation_xml | – name: 3 Cardiology Department Hospital Germans Trias i Pujol, Universitat Autónoma de Barcelona Barcelona Spain – name: 2 Cardiology Department Hospital del Mar Barcelona Spain – name: 1 Cardiology Department Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona Barcelona Spain – name: 4 Cardiology Department Hospital Doctor Josep Trueta Gerona Spain |
| Author_xml | – sequence: 1 givenname: Mercedes orcidid: 0000-0002-8704-3104 surname: Rivas‐Lasarte fullname: Rivas‐Lasarte, Mercedes organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 2 givenname: Alba orcidid: 0000-0003-1785-3125 surname: Maestro fullname: Maestro, Alba organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 3 givenname: Juan surname: Fernández‐Martínez fullname: Fernández‐Martínez, Juan organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 4 givenname: Laura surname: López‐López fullname: López‐López, Laura organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 5 givenname: Eduard orcidid: 0000-0002-5727-9925 surname: Solé‐González fullname: Solé‐González, Eduard organization: Hospital del Mar – sequence: 6 givenname: Miquel surname: Vives‐Borrás fullname: Vives‐Borrás, Miquel organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 7 givenname: Santiago orcidid: 0000-0002-0984-3472 surname: Montero fullname: Montero, Santiago organization: Hospital Germans Trias i Pujol, Universitat Autónoma de Barcelona – sequence: 8 givenname: Nuria surname: Mesado fullname: Mesado, Nuria organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 9 givenname: Maria J. surname: Pirla fullname: Pirla, Maria J. organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 10 givenname: Sonia surname: Mirabet fullname: Mirabet, Sonia organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 11 givenname: Paula surname: Fluvià fullname: Fluvià, Paula organization: Hospital Doctor Josep Trueta – sequence: 12 givenname: Vicens surname: Brossa fullname: Brossa, Vicens organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 13 givenname: Alessandro orcidid: 0000-0003-0843-9512 surname: Sionis fullname: Sionis, Alessandro organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 14 givenname: Eulàlia surname: Roig fullname: Roig, Eulàlia organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 15 givenname: Juan orcidid: 0000-0003-4819-4265 surname: Cinca fullname: Cinca, Juan organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona – sequence: 16 givenname: Jesús orcidid: 0000-0002-2015-6446 surname: Álvarez‐García fullname: Álvarez‐García, Jesús email: jalvarezg@santpau.cat organization: Hospital de la Santa Creu i Sant Pau, IIb‐SantPau, CIBERCV, Universitat Autónoma de Barcelona |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32633473$$D View this record in MEDLINE/PubMed |
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| Copyright | 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. 2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| DOI | 10.1002/ehf2.12842 |
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| Keywords | Heart failure Prognosis Lung ultrasound Pulmonary congestion |
| Language | English |
| License | Attribution-NonCommercial 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
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| References_xml | – volume: 12 start-page: 423 end-page: 433 article-title: Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine publication-title: Eur J Heart Fail – volume: 137 start-page: 1671 year: 2018 end-page: 1683 article-title: NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide)‐guided therapy in acute decompensated heart failure publication-title: Circulation – volume: 44 start-page: 1212 year: 2018 end-page: 1216 article-title: Sources of variability in the detection of B‐lines, using lung ultrasound publication-title: Ultrasound Med Biol – volume: 6 start-page: 543 year: 2018 end-page: 551 article-title: The role of the clinical examination in patients with heart failure publication-title: JACC Hear Fail – volume: 218 start-page: 104 year: 2016 end-page: 108 article-title: 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doi: 10.1016/j.cardfail.2007.07.003 – start-page: 1 year: 2019 ident: e_1_2_9_12_1 article-title: Lung ultrasound‐guided treatment in ambulatory patients with heart failure: a randomised controlled clinical trial (LUS‐HF study) publication-title: Eur J Heart Fail – ident: e_1_2_9_8_1 doi: 10.1016/j.jchf.2019.07.008 – ident: e_1_2_9_26_1 doi: 10.2459/JCM.0000000000000226 – ident: e_1_2_9_22_1 doi: 10.1016/j.cardfail.2015.02.004 – ident: e_1_2_9_15_1 doi: 10.1016/j.jacc.2017.04.025 – ident: e_1_2_9_11_1 doi: 10.1002/ejhf.344 – ident: e_1_2_9_27_1 doi: 10.1111/acem.12651 – ident: e_1_2_9_5_1 doi: 10.1161/CIRCHEARTFAILURE.114.001957 – ident: e_1_2_9_9_1 doi: 10.1016/j.ijcard.2017.02.150 – ident: e_1_2_9_23_1 doi: 10.1016/j.ijcard.2016.05.010 – ident: e_1_2_9_10_1 doi: 10.1093/eurheartj/ehv745 – ident: e_1_2_9_24_1 doi: 10.1007/s00392-018-1221-7 – ident: e_1_2_9_29_1 doi: 10.1016/j.ajem.2015.06.002 – ident: e_1_2_9_20_1 doi: 10.1016/j.jcmg.2013.08.004 – ident: e_1_2_9_14_1 doi: 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| Snippet | Aims
Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound... Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS).... AimsResidual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound... Aims Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound... Abstract Aims Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung... |
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| SubjectTerms | Auscultation Cardiac arrhythmia Diuretics Heart failure Lung ultrasound Original Original s Peptides Population Prognosis Pulmonary congestion Ultrasonic imaging |
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| Title | Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure |
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