Improving Pulmonary Congestion Assessment in Heart Failure with Preserved Ejection Fraction

摘要 射血分数保留性心力衰竭（HFpEF）是一种特别难以诊断的综合征， 然而，据估计，它影响了>50%的HF患者。美国因心力衰竭住院人数超过100万 每年和一年的死亡率高达29%，HFpEF的健康和经济影响是巨大的。的 在门诊环境中早期检测容量超负荷对于优化充血治疗至关重要， 需要住院治疗的明显失代偿。肺充血是肺容量超负荷的标志， HFpEF在最终导致住院的失代偿进展中起核心作用。 然而，目前用于其检测的诊断方法不敏感。我们的中心假设是， 在HFpEF中通过肺超声（LUS）评估肺充血将优于目前可用的方法 接近。LUS是一种新型的、非侵入性的、廉价的肺充血定量工具。 通过这项研究，我们将扩大我们以前的工作，以了解如何在门诊使用这种方法， 用于识别已知或疑似HFpEF患者的肺充血。我们的长期目标是 在该人群中开展早期干预，改善生活质量，减少HF住院和费用。 我们的具体目标是：1）确定肺充血的肺部超声检查结果的患病率， 在HFpEF患者中，其超声心动图、生物标志物和生活质量相关。2A.调查 肺超声检测肺充血对非卧床患者不良HF事件的预后价值 HFpEF患者。2B）为患有以下疾病的非卧床患者制定并验证以排尿为重点的风险评分： HFpEF整合临床、超声和生物标志物发现。我们的方法是创新的， 在传统上难以诊断的HFpEF患者队列中评估容量状态的方法，以及 采用廉价的即时护理设备，并与省时、易学的成像协议配对。 这一建议意义重大，因为它将提供有关增量的至关重要的信息。 LUS检测HFpEF非卧床患者肺充血的价值。因此，它是一个 改善HF高危患者容量超负荷早期检测的关键一步 住院和相关的发病率，死亡率和成本。

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.