Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients
Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients
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DOI：
10.1093/eurheartj/ehv745
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发表时间：
2016-04-14
影响因子：
39.3
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
--
作者：
Platz, Elke;Lewis, Eldrin F.;Solomon, Scott D.
目的肺充血是心力衰竭（HF）常见的重要表现。虽然临床检查和胸部X线摄影是不敏感的，肺超声（LUS）是一种新的技术，可以检测和量化亚临床肺充血。我们试图将LUS和临床结果与6个月的HF住院和全因死亡率（复合主要结局）独立相关。方法我们在常规心脏病学门诊就诊期间使用LUS检查了195例NYHA II-IV级HF患者（中位年龄66岁，61%男性，74%白色，射血分数34%）。肺部超声进行了8个胸部区域的口袋超声设备（中位数检查持续时间2分钟）和分析offline.Results在185例患者有足够的LUS图像在所有区域，B线（垂直线LUS）的总和范围从0到13。通过三分位数分析，B线与充血的临床和实验室标志物相关。32%的患者在LUS上显示>= 3条B线，但其中81%的患者在听诊时没有发现。在随访期间，50例患者（27%）因HF住院或死亡。第三个三分位数的患者（>= 3条B线）的主要结局风险高4倍（调整后HR 4.08，95%置信区间，CI 1.95，8.54; P < 0.001）与第一个三分位数相比，结论超声评估的肺充血在非卧床慢性HF患者中普遍存在，与临床充血的其他特征相关，并识别出预后较差的患者。
Aims Pulmonary congestion is a common and important finding in heart failure (HF). While clinical examination and chest radiography are insensitive, lung ultrasound (LUS) is a novel technique that may detect and quantify subclinical pulmonary congestion. We sought to independently relate LUS and clinical findings to 6-month HF hospitalizations and all-cause mortality (composite primary outcome).Methods We used LUS to examine 195 NYHA class II-IV HF patients (median age 66, 61% men, 74% white, ejection fraction 34%) during routine cardiology outpatient visits. Lung ultrasound was performed in eight chest zones with a pocket ultrasound device (median exam duration 2 min) and analysed offline.Results In 185 patients with adequate LUS images in all zones, the sum of B-lines (vertical lines on LUS) ranged from 0 to 13. B-lines, analysed by tertiles, were associated with clinical and laboratory markers of congestion. Thirty-two per cent of patients demonstrated >= 3 B-lines on LUS, yet 81% of these patients had no findings on auscultation. During the follow-up period, 50 patients (27%) were hospitalized for HF or died. Patients in the third tertile (>= 3 B-lines) had a four-fold higher risk of the primary outcome (adjusted HR 4.08, 95% confidence interval, CI 1.95, 8.54; P < 0.001) compared with those in the first tertile and spent a significantly lower number of days alive and out of the hospital (125 days vs. 165 days; adjusted P < 0.001).Conclusions Pulmonary congestion assessed by ultrasound is prevalent in ambulatory patients with chronic HF, is associated with other features of clinical congestion, and identifies those who have worse prognosis.