Diagnostic and Prognostic Value of Lung Ultrasound B-Lines in Acute Heart Failure With Concomitant Pneumonia.

Matteo Mazzola,Nicolò De Biase,Chiara Piazzai,Giorgia Barbarisi,Nicola Riccardo Pugliese,Giulia Bandini,Alberto Moggi-Pignone,Luna Gargani,Martina Zavagli,Stefano Masi,Gennaro D'Angelo,Simon David,Michela Sollazzo

doi:10.3389/fcvm.2021.693912

Abstract

Purpose: To evaluate the potential confounding effect of concomitant pneumonia (PNM) on lung ultrasound (LUS) B-lines in acute heart failure (AHF).Methods: We enrolled 86 AHF patients with (31 pts, AHF/PNM) and without (55 pts, AHF) concomitant PNM. LUS B-lines were evaluated using a combined antero-lateral (AL) and posterior (POST) approach at admission (T0), after 24 h from T0 (T1), after 48 h from T0 (T2) and before discharge (T3). B-lines score was calculated at each time point on AL and POST chest, dividing the number of B-lines by the number of explorable scanning sites. The decongestion rate (DR) was calculated as the difference between the absolute B-lines number at discharge and admission, divided by the number of days of hospitalization. Patients were followed-up and hospital readmission for AHF was considered as adverse outcome.Results: At admission, AHF/PNM patients showed no difference in AL B-lines score compared with AHF patients [AHF/PNM: 2.00 (IQR: 1.44–2.94) vs. AHF: 1.65 (IQR: 0.50–2.66), p = 0.072], whereas POST B-lines score was higher [AHF/PNM: 3.76 (IQR: 2.70–4.77) vs. AHF = 2.44 (IQR: 1.20–3.60), p < 0.0001]. At discharge, AL B-lines score [HR: 1.907 (1.097–3.313), p = 0.022] and not POST B-lines score was found to predict adverse events (AHF rehospitalization) after a median follow-up of 96 days (IQR: 30–265) in the overall population.Conclusions: Assessing AL B-lines alone is adequate for diagnosis, pulmonary congestion (PC) monitoring and prognostic stratification in AHF patients, despite concomitant PNM.

Highlights

Concomitant pneumonia (PNM) is commonly observed in elderly patients admitted for acute heart failure (AHF) to Internal Medicine Departments [1, 2] with a high prevalence of comorbidities
At admission, AHF/PNM patients showed no difference in AL B-lines score compared with AHF patients [AHF/PNM: 2.00 (IQR: 1.44–2.94) vs. AHF: 1.65 (IQR: 0.50–2.66), p = 0.072], whereas POST B-lines score was higher [AHF/PNM: 3.76 (IQR: 2.70–4.77) vs. AHF = 2.44 (IQR: 1.20–3.60), p < 0.0001]
Assessing AL B-lines alone is adequate for diagnosis, pulmonary congestion (PC) monitoring and prognostic stratification in AHF patients, despite concomitant PNM

Summary

Introduction

Concomitant pneumonia (PNM) is commonly observed in elderly patients admitted for acute heart failure (AHF) to Internal Medicine Departments [1, 2] with a high prevalence of comorbidities (e.g., diabetes mellitus and COPD). On the other hand, being an indirect effect of the increase in extravascular lung water (EVLW), LUS B-lines provide the clinician with an accurate, non-invasive and low-cost technique for pulmonary congestion (PC) evaluation in AHF patients. Substantial evidence supports this echographic approach as a useful diagnostic tool and valid prognosticator in emergency departments and outpatient clinics [11,12,13,14,15,16,17,18,19]. In previous studies on LUS B-lines in HF management, only AL areas have been taken into account as scanning sites and, to the best of our knowledge, this is the first study to include a comprehensive AL and POST B-lines evaluation in AHF patients

Objectives

Methods

Results

Conclusion