Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF
Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF
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DOI：
10.1007/s00392-018-1221-7
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发表时间：
2018-07-01
影响因子：
5
通讯作者：
Cleland, John G.
中科院分区：
文献类型：
--
作者：
Palazzuoli, Alberto;Ruocco, Gaetano;Cleland, John G.
肺超声（LUS）可用于急性心力衰竭（AHF）患者通过b线成像（“彗星”）评估肺充血。目的探讨左室射血分数保留（HFpEF）或降低（HFrEF）的AHF患者入院和出院时b线、血浆b型利钠肽（BNP）浓度与超声心动图左室（LV）功能的关系及其与预后的关系。方法AHF患者在入院和出院时均进行上述检查。主要结局是6个月时因心力衰竭或死亡再次住院。结果纳入的162例患者中，HFrEF患者95例，HFpEF患者67例，中位年龄为80岁[77-85]岁，其中85例（52%）为女性。入院时b线数（中位数31条[27-36]）与呼吸频率（r = 0.75, p < 0.001）、BNP （r = 0.43, p < 0.001）、临床充血评分（r = 0.25, p = 0.001）、肺动脉收缩压（r = 0.42, p < 0.001）相关。出院时，b线也与BNP （r = 0.69, p < 0.001）和充血评分（r = 0.57, p < 0.001）相关。出院时b线计数预测预后（AUC 0.83[0.77-0.90]；单变量HR 1.12[1.09-1.16]；多变量HR 1.16 [1.11-1.21]; p < 0.001）。HFpEF和HFrEF的结果相似。结论LUS是评估肺充血严重程度和监测病情缓解的有效方法。入院时，b线与呼吸频率密切相关，这可能是呼吸困难感觉的关键组成部分。出院时肺充血的测量为HFpEF或HFrEF患者提供了预后信息。
Background Lung ultrasound (LUS) can be used to assess pulmonary congestion by imaging B-lines ('comets') for patients with acute heart failure (AHF).Objectives Investigate relationship of B-lines, plasma concentrations of B-type natriuretic peptide (BNP), and echocardiographic left ventricular (LV) function measured at admission and discharge and their relationship to prognosis for AHF with preserved (HFpEF) or reduced (HFrEF) LV ejection fraction.Methods Patients with AHF had the above tests done at admission and discharge. The primary outcome was re-hospitalization for heart failure or death at 6 months.Results Of 162 patients enrolled, 95 had HFrEF and 67 had HFpEF, median age was 80 [77-85] years, and 85 (52%) were women. The number of B-lines at admission (median 31 [27-36]) correlated with respiratory rate (r = 0.75; p < 0.001), BNP (r = 0.43; p < 0.001), clinical congestion score (r = 0.25; p = 0.001), and systolic pulmonary artery pressure (r = 0.42; p < 0.001). At discharge, B-lines were also correlated with BNP (r = 0.69; p < 0.001) and congestion score (r = 0.57; p < 0.001). B-line count at discharge predicted outcome (AUC 0.83 [0.77-0.90]; univariate HR 1.12 [1.09-1.16]; p < 0.001; multivariable HR 1.16 [1.11-1.21]; p < 0.001). Results were similar for HFpEF and HFrEF.Conclusions LUS appears a useful method to assess severity and monitor the resolution of lung congestion. At hospital admission, B-lines are strongly related to respiratory rate, which may be a key component of the sensation of dyspnea. Measurement of lung congestion at discharge provides prognostic information for patients with either HFpEF or HFrEF.