B-lines by lung ultrasound predict heart failure in hospitalized patients with acute anterior wall STEMI
B-lines by lung ultrasound predict heart failure in hospitalized patients with acute anterior wall STEMI
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DOI：
10.1111/echo.14420
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发表时间：
2019-07-09
影响因子：
1.5
通讯作者：
Li, Xian-Lun
中科院分区：
文献类型：
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作者：
Ye, Xiao-Jun;Li, Nan;Li, Xian-Lun
肺部超声 (LUS) 客观 B 线成像是评估亚临床肺充血的新工具。本研究的目的是探讨入院时 B 线编号对预测急性前壁 STEMI 患者住院期间症状性心力衰竭 (HF) 的预后价值。方法本研究为前瞻性队列研究，连续纳入96例入院时无呼吸困难的前壁STEMI患者。初次 PCI 后 5 小时内进行肺部听诊、NT-proBNP 测试、LUS 和超声心动图检查。记录啰音发生情况、血浆NT-proBNP水平、B线数、LVEF、E/e’，分析其对院内心力衰竭的预测价值。结果共有19名患者出现症状性心力衰竭。 HF 组的中位 B 线数、NT-proBNP 水平和 E/e' 高于非心力衰竭 (NHF) 组 (P < 0.001)，而 LVEF 较低 (P = 0.002)。两组之间的啰音发生率无统计学差异。多变量逻辑回归表明，B 线、E/e' 和 NT-proBNP 独立预测住院期间的心力衰竭。根据ROC曲线下面积，最强的预测因子是B-lines（0.972），其次是NT-proBNP（0.936）和E/e'（0.928），并且将三个指标结合起来优于任何单个参数（P = 0.048）。 B 线截止值 >= 18 可以很好地预测 HF 事件，特异性和敏感性分别为 94.7% 和 94.8%。结论 B线反映的亚临床肺淤血可独立预测前壁STEMI患者住院期间症状性心力衰竭，LUS可作为评估心功能的补充工具。
Objective B-line imaging by lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. The aim of this study was to explore the prognostic value of B-line number at admission in predicting symptomatic heart failure (HF) during hospitalization in acute anterior wall STEMI patients. Methods This was a prospective cohort study which consecutively enrolled 96 anterior wall STEMI patients without dyspnea at admission. Pulmonary auscultation, NT-proBNP test, LUS, and echocardiography were performed within 5 hours after primary PCI. Rale occurrence, plasma NT-proBNP levels, B-line number, LVEF, E/e' were recorded, and their predictive value for HF in-hospital was analyzed. Results A total of 19 patients developed symptomatic HF. Median B-line number, NT-proBNP levels, and E/e' in the HF group were higher than those of the nonheart-failure (NHF) group (P 0.001) while LVEF was lower (P = 0.002). There was no statistical difference in rale occurrence between the two groups. Multivariate logistic regression demonstrated that B-lines, E/e', and NT-proBNP independently predicted HF during hospitalization. According to the area under the ROC curve, the strongest predictor is B-lines (0.972), followed by NT-proBNP (0.936) and E/e' (0.928), and combining the three indicators was better than any single parameter (P = 0.048). B-line cutoff >= 18 could well predict HF event with specificity and sensitivity of 94.7% and 94.8%, respectively. Conclusion Subclinical pulmonary congestion reflected by B-lines can independently predict symptomatic HF during hospitalization in patients with anterior wall STEMI, LUS will act as a complementary tool for evaluating cardiac function.