Improving Pulmonary Congestion Assessment in Heart Failure with Preserved Ejection Fraction

摘要 心力衰竭伴保留射血分数(HFpEF)是一种特别难诊断和 然而，据估计，它会影响50%的心衰患者。在美国，有100万人因心力衰竭住院。 每年和一年的死亡率高达29%，HFpEF对健康和经济的影响是巨大的。这个 在门诊环境中及早发现容量超负荷是优化减充血治疗的关键 弗兰克失代偿需要住院治疗。肺充血，容量超负荷的标志 HFpEF在最终导致入院的失代偿过程中发挥着核心作用。 然而，目前对其检测的诊断方法是不敏感的。我们的中心假设是 肺超声(LUS)对肺充血的评估在HFpEF中将优于目前可用的 接近了。LUS是一种新的、非侵入性的、廉价的肺充血定量工具。 通过这项研究，我们将扩展我们之前的工作，以了解如何在门诊中使用这种方法 设置以识别已知或可疑HFpEF患者的肺充血。我们的长期目标是 在这一人群中启动早期干预，提高生活质量，减少心衰住院和费用。 我们的具体目标是：1)确定肺充血的肺部超声征象的流行率和 HFpEF患者的超声心动图、生物标志物和生活质量相关。2a)调查 动态肺超声检测肺充血对心力衰竭不良事件的预后价值 HFpEF组2例。2b)为有以下情况的门诊患者制定和验证以拥堵为重点的风险评分 HFpEF综合了临床、超声和生物标记物的发现。我们的方法是创新的，专注于 在传统上难以诊断的HFpEF患者队列中评估容量状况的方法，以及 采用价格低廉的医疗设备，配以省时、易学的成像方案。 这项建议意义重大，因为它将提供有关增量 LUS检测HFpEF患者动态肺充血的价值。因此，它是一种 提高心力衰竭高危患者容量超负荷早期检测的关键一步 住院以及相关的发病率、死亡率和费用。

ABSTRACT Heart failure with preserved ejection fraction (HFpEF) is a syndrome that is particularly difficult to diagnose and treat, yet, it is estimated to affect >50% of patients with HF. With >1 million hospitalizations for HF in the U.S. annually and one-year mortality rates up to 29%, the health and economic impact of HFpEF is substantial. The early detection of volume overload in the outpatient setting is critical to optimize decongestive therapy prior to frank decompensation requiring hospitalization. Pulmonary congestion, a hallmark of volume overload in HFpEF, plays a central role in the progression of decompensation ultimately leading to hospital admission. However, current diagnostic methods for its detection are insensitive. Our central hypothesis is that the assessment of pulmonary congestion by lung ultrasound (LUS) in HFpEF will outperform currently available approaches. LUS is a novel, non-invasive and inexpensive tool in the quantification of pulmonary congestion. With this study, we will expand our prior work to understand how this method could be utilized in an ambulatory setting to identify pulmonary congestion in patients with known or suspected HFpEF. Our long-term goal is to initiate early intervention, improve quality of life, and reduce HF hospitalizations and costs in this population. Our specific aims are: 1) Determine the prevalence of lung ultrasound findings of pulmonary congestion and their echocardiographic, biomarker and quality of life correlates in patients with HFpEF. 2A) Investigate the prognostic value of lung ultrasound-detected pulmonary congestion for adverse HF events in ambulatory patients with HFpEF. 2B) Develop and validate a congestion-focused risk score for ambulatory patients with HFpEF integrating clinical, ultrasound and biomarker findings. Our approach is innovative by focusing on new approaches to volume status assessment in a traditionally difficult to diagnose cohort of HFpEF patients, and employing an inexpensive point-of-care device paired with a time-efficient, easily learned imaging protocol. This proposal is significant because it will provide critically important information regarding the incremental value of LUS for the detection of pulmonary congestion in ambulatory patients with HFpEF. It is therefore a critical step toward improving the early detection of volume overload in patients at high risk for HF hospitalizations and the associated morbidity, mortality and cost.