Lung comets ultrasound and prediction of one year mortality and chronic ischemic heart faillure

Abstract

Abstract Background Lung ultrasound can be used to assess pulmonary congestion by imaging B-lines for patients with heart failure after acute coronary syndromes, it is a major risk marker for morbidity and mortality. Purpose The objective of the study is to determine the role of pulmonary B lines in the acute phase of acute coronary syndromes in the prediction of the risk of mortality and chronic ischemic heart failure after 1 year of discharge Methods We conducted a prospective monocentric follow-up study with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 with acute coronary syndromes. 304 consecutive patients underwent clinical examination, echocardiography, and lung ultrasound in the acute phase, independently of, and in addition to routine management by the attending physicians. Results We find in the general population, Killip stage ≥ II in 22.4% of patients, the median B-line count was 5 (0–16).In patients with ≥30 B-lines; we have 17.8% STEMI, 12.7% NSTEMI and 9.3% unstable angina, twelve-month event-free survival for the primary endpoint (all-cause death or heart faillure) was 31.7% in patients with ≥30 B-lines and 68.3% in those with <30 B-lines (P<0.0001), 33.5% of the general population have signs of chronic ischemic heart failure after one year of follow-up, 22.5% with HFpEF and 78.5% with HFrEF, B-lines ≥16 in 58.7% patients with HFrEF and 17.4% with HFpEF, Pulmonary ultrasound B-lines in admission are an independent risk factor for all-cause mortality and chronic ischemic heart failure after 1 year of acute coronary syndrome (HR 1.80; IC 95%=1.48–2.18, p<0.001), Pulmonary comets are also an independent predictor of chronic ischemic HFrEF risk (HR 1.62; IC 95%=1.26–2.07, p<0.001) and of chronic ischemic HFpEF (HR 1.54; IC 95%=1.01–2.37, p=0.04). Discussion With respect to B-line assessment as a prognostic tool at discharge in chronic ischemic HF patients, evidence is scarce, some studies reported that B-lines were associated with a two-fold increase in the rate of death, myocardial infarction, or HF hospitalisation at follow-up. However, in other study the B lines are part of the evaluation variables of an echocardiographic prognostic score as in the Bedetti series, their application as a simple prognostic tool for evaluation is an important contribution to guide management. Conclusion Ultrasonic pulmonary comets are a strong predictor of the residual risk of mortality and chronic ischemic heart failure and allowing a significant prognosis reclassification. Multicenter studies evaluating whether this tool could ultimately guide therapy optimization are warranted. Funding Acknowledgement Type of funding sources: None.