Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

BACKGROUND: The usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial. PURPOSE: We aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF. MATERIALS AND METHODS:...

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Detalles Bibliográficos
Autores principales: Li, Yan, Ai, Hu, Ma, Na, Li, Peng, Ren, Junhong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Cardiovascular Medicine
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441745/
https://www.ncbi.nlm.nih.gov/pubmed/36072884
http://dx.doi.org/10.3389/fcvm.2022.943633
Descripción
Sumario:BACKGROUND: The usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial. PURPOSE: We aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through systematic searches of MEDLINE, EMBASE, the Cochrane Database, Google Scholar, and SinoMed. The primary outcome was MACEs (a composite of all-cause mortality, HF-related rehospitalization, and symptomatic HF). The required information size was calculated by trial sequential analysis (TSA). RESULTS: In total, ten RCTs involving 1,203 patients were included. Overall, after a mean follow-up period of 4.7 months, LUS-guided treatment was associated with a significantly lower risk of MACEs than usual care [relative risk (RR), 0.59; 95% confidence interval (CI), 0.48–0.71]. Moreover, the rate of HF-related rehospitalization (RR, 0.63; 95% CI, 0.40–0.99) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration (standardized mean difference, –2.28; 95% CI, –4.34 to –0.22) were markedly lower in the LUS-guided treatment group. The meta-regression analysis showed a significant correlation between MACEs and the change in B-line count (p < 0.05). The subgroup analysis revealed that the risk of MACEs was markedly lower in patients aged up to 70 years (RR, 0.54; 95% CI, 0.44–0.67), with a lower rate of atrial fibrillation (< 27.2%) (RR, 0.53; 95% CI, 0.43–0.67), and with a lower NT-proBNP concentration (< 3,433 pg/ml) (RR, 0.51; 95% CI, 0.40–0.64). TSA indicated a lower risk of MACEs with LUS-guided treatment than with usual care among patients with HF (p < 0.05). CONCLUSION: Lung ultrasound seems to be a safe and effective method to guide HF treatment. SYSTEMATIC REVIEW REGISTRATION: [https://inplasy.com/], identifier [INPLASY202220124].

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