Lung Ultrasound in Acute Heart Failure: Prevalence of Pulmonary Congestion and Short- and Long-Term Outcomes.
Lung Ultrasound in Acute Heart Failure: Prevalence of Pulmonary Congestion and Short- and Long-Term Outcomes.
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DOI：
10.1016/j.jchf.2019.07.008
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发表时间：
2019-10
期刊：
影响因子：
--
通讯作者：
McMurray JJV
中科院分区：
文献类型：
--
作者：
Platz E;Campbell RT;Claggett B;Lewis EF;Groarke JD;Docherty KF;Lee MMY;Merz AA;Silverman M;Swamy V;Lindner M;Rivero J;Solomon SD;McMurray JJV
使用简化的肺部超声(LUS)方法，评估急性心力衰竭(AHF)患者肺充血指标B线的患病率、变化和预后重要性。肺充血是AHF的重要表现，但传统的肺充血检测方法敏感性较低。在一项两点的前瞻性观察性研究中，在AHF住院期间(LUS1)和出院时(LUS2)早期进行了4区LUS。B线被离线量化，由核心实验室对临床结果和结果视而不见。在349例患者中(中位年龄75岁，男性59%，平均EF39%)，4个区域的B线总和从0到18(LUS1)。不良住院事件的风险随着LUS1B线数目的增加而增加：每条B线的优势比为1.82(95%CI1.14~2.88，P=0.011)。在6天(中位数)内，B-线计数从中位数6(LUS1)下降到4(LUS2；P<；0.001)。在132例有LUS2图像的患者中，出院时B线数目较高的患者心衰住院或全因死亡的风险更大。这种关系离出院更近：60天未调整心率：3.3，95%可信区间1.52~7.17，P=0.002；90天：2.94，1.46~5.93，P=0.003；180d：2.01，1.11~3.64，P=0.021。在调整了包括NT-proBNP在内的重要临床变量后，B线数目与短期和长期结果之间的关联仍然存在。使用简化的四区LUS方法的肺充血在AHF中很常见，并随着治疗的改善而改善。基线和出院时较高的B线数字表明患者发生不良事件的风险增加。
To assess the prevalence, changes in and prognostic importance of B-lines, a pulmonary congestion measure, using a simplified lung ultrasound (LUS) method in acute heart failure (AHF). Pulmonary congestion is an important finding in AHF, however, traditional methods for its detection are insensitive. In a two-site, prospective, observational study 4-zone LUS was performed early during hospitalization for AHF (LUS1) and at discharge (LUS2). B-lines were quantified offline, blinded to clinical findings and outcomes by a core laboratory. Among 349 patients (median age 75, 59% men, mean EF 39%) the sum of B-lines in 4 zones ranged from 0 to 18 (LUS1). The risk of an adverse in-hospital event increased with rising B-line number on LUS1: odds ratio for each B-line tertile 1.82 (95% CI 1.14–2.88, P=0.011). B-line count decreased from a median of 6 (LUS1) to 4 (LUS2; P<0.001) over 6 days (median). In 132 patients with LUS2 images, the risk of HF hospitalization or all-cause death was greater in patients with a higher B-line number at discharge. This relationship was stronger closer to discharge: unadjusted HR 60 days: 3.30, 95% CI 1.52–7.17, P=0.002; 90 days: 2.94, 1.46–5.93, P=0.003; 180 days: 2.01, 1.11–3.64, P=0.021. The association between B-line number and short and long-term outcomes persisted after adjusting for important clinical variables, including NT-proBNP. Pulmonary congestion using a simplified 4-zone LUS method was common in AHF and improved with therapy. A higher B-line number at baseline and discharge identified patients at increased risk for adverse events.
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作者：
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