A different use of the CHA2DS2-VASc: Risk stratification of early recurrence of atrial fibrillation

Abstract

line, deepening posteriorly and moving synchronously with respiration) allows semiquantification and monitoring of extravascular lung water, and B-line score at admission has been identified as a prognostic factor in patients hospitalised for HF. Objective: Aim of our study was to evaluate if LUS performed at patient's discharge could predict 90-day readmission or death in HF patients. Methods: Consecutive patients hospitalised for HF exacerbation were enrolled from September 2011 to September 2012. Exclusion criteria were: bedridden patients, acute coronary syndromes, pneumonia in the last month, and pulmonary fibrosis. All patients received conventional treatments as suggested by the guidelines. Echocardiography was performed in each patient. At discharge LUS was performed through longitudinal scans following anatomical lines; B lines were counted in each intercostal space; as previously described in literature, 72 segments were considered (28 anteriorly, and 44 posteriorly). Sector was considered positive when at least two B-lines were recognized. The percentage of positive sectors was calculated. Phone-call follow-up at 90 days was performed and events of readmission or death were registered. A logistic regression analysis was performed to evaluate the association between the percentage of positive sectors and 90 day events. Data are expressed as mean ± SD. Results: Eighty patients were enrolled (59% females; age 78 ± 9 yrs); NYHA class II or III patients were 87%; ejection fraction was 45 ± 17. Twenty-four events were recorded (18 readmissions, 6 deaths). B lines were significantly associated with events (OR = 1.05, 95%CI 1.02–1.08; p = 0.0007). This association was confirmed when the model was adjusted for age, EF, left atrial volume, E/E′, haemoglobin, creatinine. Conclusions: B lines at discharge may represent a prognostic factor for readmission and death at 90 days in HF patients.