Abstract
BackgroundManagement of congestive heart failure (CHF) is dependent on clinical assessments of volume status, which are subjective and imprecise. Point-of-care ultrasound (POCUS) is useful in the diagnosis of CHF, but how POCUS findings correlate with therapy remains unknown. This study aimed to determine whether the changes in clinical evaluation of CHF with treatment are mirrored with changes in the number of B lines on lung ultrasound (LUS) and inferior vena cava (IVC) size. In this prospective observational study, investigators performed serial clinical and ultrasound assessments within 24 h of admission (T1), day 1 in hospital (T2) and within 24 h of discharge (T3). Clinical assessments included an evaluation of the jugular venous distension (JVD), hepatojugular reflux (HJR), pulmonary rales and a clinical congestion score was calculated. Ultrasound assessment included the IVC size and collapsibility, and the number of B lines in an 8-point scan.ResultsFifty consecutive patients were recruited with a mean age of 71.2 years (SD 12.7). Mean clinical congestion score on admission was 5.6 (SD 1.4) and declined significantly over time to 1.3 (0.91), as did the JVP, HJR and pulmonary rales. No significant changes were found in the IVC size between T1 [1.9 (0.65)] and T3 [2.0 (0.50)] or in the IVC collapsibility index [T1 0.3 (0.19) versus T3 0.25 (0.16)]. The mean number of B lines decreased from 11 (6.1) at T1 to 8.3 (5.5) at T3, although this decrease did not reach statistical significance. Spearman correlation between JVP and HJR versus IVC collapsibility and total B lines did not yield significant results.ConclusionsClinical exam findings correlate over time during the management of CHF, whereas LUS and IVC results did not. The number of B lines did decrease with therapy, but did not reach statistical significance likely because the sampled population was small and had only mild heart failure. Further studies are warranted to further explore the use of lung ultrasound in this patient population.
Highlights
Management of congestive heart failure (CHF) is dependent on clinical assessments of volume status, which are subjective and imprecise
Five patients were excluded because they had a primary diagnosis of pneumonia complicated by pulmonary edema, and one patient was excluded because CHF was not the final diagnosis
The present study showed no significant change in inferior vena cava (IVC) size or collapsibility index despite significant improvement in clinical signs of congestion in patients treated for acute decompensated heart failure
Summary
Management of congestive heart failure (CHF) is dependent on clinical assessments of volume status, which are subjective and imprecise. This study aimed to determine whether the changes in clinical evaluation of CHF with treatment are mirrored with changes in the number of B lines on lung ultrasound (LUS) and inferior vena cava (IVC) size In this prospective observational study, investigators performed serial clinical and ultrasound assessments within 24 h of admission (T1), day 1 in hospital (T2) and within 24 h of discharge (T3). The gold standard for determining cardiac congestion is cardiac catheterization with determination of right atrial and left atrial pressures, as estimated by the Spevack et al Crit Ultrasound J (2017) 9:7 pulmonary capillary wedge pressures These tests are invasive, time consuming and carry risk, and are not typically performed in patients admitted with decompensated heart failure [8]. Correlates poorly with invasive hemodynamics [9] and the physical exam lacks sensitivity and specificity for the diagnosis of heart failure, limiting its clinical utility [10]
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