Prognostic value of pulmonary congestion assessed by lung ultrasound to predict decompensation in heart failure patients

Abstract

Lung ultrasound (LUS) evaluation of B lines has been demonstrated to be a valid tool for the assessment and monitoring of pulmonary congestion in heart failure (HF) patients. Data on the long-term outcome of patients presenting with B lines is lacking. The aim of this study was to evaluate their long-term prognosis, with a primary endpoint of rehospitalization for heart failure and/or death. Ninety-one patients presenting with significant dyspnea (NYHA ≥ 2) underwent an initial analysis of LUS for B-lines, complete TTE and left heart catheterization to evaluate left ventricular end diastolic pressure (LVEDP). They were prospectively followed up for an average duration of 803 days ± 113 days. 13 patients presented with heart failure, and 13 patients died. ROC analysis showed an optimal cutoff of B-lines at 6. Kaplan–Meier curves showed a significant difference in rehospitalization for heart failure at 1 year ( P = 0,047 for B-lines ≥ 6). There was no significant difference for death. B-lines were a better predictor of heart failure than elevated LVEDP ( P = 0,174), or elevated left ventricular pressured based on the EACVI algorithm for TTE ( P = 0,763) ( Fig. 1 , Table 1 ). B-lines assessment by LUS identifies patients more likely to be admitted for decompensated HF in the following year, and appears superior to classical echocardiographic strategies. This tool should be considered in a multi-parametric approach in patients with heart failure to optimize treatment and follow-up.