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Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study

Background: We investigated the role of the dynamic changes of pulmonary congestion, as assessed by sonographic B-lines, as a tool to stratify prognosis in patients admitted for acute heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF). Methods: In this multicenter, prospective...

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Autores principales: Pugliese, Nicola R., Mazzola, Matteo, Bandini, Giulia, Barbieri, Greta, Spinelli, Stefano, De Biase, Nicolò, Masi, Stefano, Moggi-Pignone, Alberto, Ghiadoni, Lorenzo, Taddei, Stefano, Sicari, Rosa, Pang, Peter S., De Carlo, Marco, Gargani, Luna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917462/
https://www.ncbi.nlm.nih.gov/pubmed/36769421
http://dx.doi.org/10.3390/jcm12030773
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author Pugliese, Nicola R.
Mazzola, Matteo
Bandini, Giulia
Barbieri, Greta
Spinelli, Stefano
De Biase, Nicolò
Masi, Stefano
Moggi-Pignone, Alberto
Ghiadoni, Lorenzo
Taddei, Stefano
Sicari, Rosa
Pang, Peter S.
De Carlo, Marco
Gargani, Luna
author_facet Pugliese, Nicola R.
Mazzola, Matteo
Bandini, Giulia
Barbieri, Greta
Spinelli, Stefano
De Biase, Nicolò
Masi, Stefano
Moggi-Pignone, Alberto
Ghiadoni, Lorenzo
Taddei, Stefano
Sicari, Rosa
Pang, Peter S.
De Carlo, Marco
Gargani, Luna
author_sort Pugliese, Nicola R.
collection PubMed
description Background: We investigated the role of the dynamic changes of pulmonary congestion, as assessed by sonographic B-lines, as a tool to stratify prognosis in patients admitted for acute heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF). Methods: In this multicenter, prospective study, lung ultrasound was performed at admission and before discharge by trained investigators, blinded to clinical findings. Results: We enrolled 208 consecutive patients (mean age 76 [95% confidence interval, 70–84] years), 125 with HFrEF, 83 with HFpEF (mean ejection fraction 32% and 57%, respectively). The primary composite endpoint of cardiovascular death or HF re-hospitalization occurred in 18% of patients within 6 months. In the overall population, independent predictors of the occurrence of the primary endpoint were the number of B-lines at discharge, NT-proBNP levels, moderate-to-severe mitral regurgitation, and inferior vena cava diameter on admission. B-lines at discharge were the only independent predictor in both HFrEF and HFpEF subgroups. A cut-off of B-lines > 15 at discharge displayed the highest accuracy in predicting the primary endpoint (AUC = 0.80, p < 0.0001). Halving B-lines during hospitalization further improved event classification (continuous net reclassification improvement = 22.8%, p = 0.04). Conclusions: The presence of residual subclinical sonographic pulmonary congestion at discharge predicts 6-month clinical outcomes across the whole spectrum of acute HF patients, independent of conventional biohumoral and echocardiographic parameters. Achieving effective pulmonary decongestion during hospitalization is associated with better outcomes.
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spelling pubmed-99174622023-02-11 Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study Pugliese, Nicola R. Mazzola, Matteo Bandini, Giulia Barbieri, Greta Spinelli, Stefano De Biase, Nicolò Masi, Stefano Moggi-Pignone, Alberto Ghiadoni, Lorenzo Taddei, Stefano Sicari, Rosa Pang, Peter S. De Carlo, Marco Gargani, Luna J Clin Med Article Background: We investigated the role of the dynamic changes of pulmonary congestion, as assessed by sonographic B-lines, as a tool to stratify prognosis in patients admitted for acute heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF). Methods: In this multicenter, prospective study, lung ultrasound was performed at admission and before discharge by trained investigators, blinded to clinical findings. Results: We enrolled 208 consecutive patients (mean age 76 [95% confidence interval, 70–84] years), 125 with HFrEF, 83 with HFpEF (mean ejection fraction 32% and 57%, respectively). The primary composite endpoint of cardiovascular death or HF re-hospitalization occurred in 18% of patients within 6 months. In the overall population, independent predictors of the occurrence of the primary endpoint were the number of B-lines at discharge, NT-proBNP levels, moderate-to-severe mitral regurgitation, and inferior vena cava diameter on admission. B-lines at discharge were the only independent predictor in both HFrEF and HFpEF subgroups. A cut-off of B-lines > 15 at discharge displayed the highest accuracy in predicting the primary endpoint (AUC = 0.80, p < 0.0001). Halving B-lines during hospitalization further improved event classification (continuous net reclassification improvement = 22.8%, p = 0.04). Conclusions: The presence of residual subclinical sonographic pulmonary congestion at discharge predicts 6-month clinical outcomes across the whole spectrum of acute HF patients, independent of conventional biohumoral and echocardiographic parameters. Achieving effective pulmonary decongestion during hospitalization is associated with better outcomes. MDPI 2023-01-18 /pmc/articles/PMC9917462/ /pubmed/36769421 http://dx.doi.org/10.3390/jcm12030773 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pugliese, Nicola R.
Mazzola, Matteo
Bandini, Giulia
Barbieri, Greta
Spinelli, Stefano
De Biase, Nicolò
Masi, Stefano
Moggi-Pignone, Alberto
Ghiadoni, Lorenzo
Taddei, Stefano
Sicari, Rosa
Pang, Peter S.
De Carlo, Marco
Gargani, Luna
Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study
title Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study
title_full Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study
title_fullStr Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study
title_full_unstemmed Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study
title_short Prognostic Role of Sonographic Decongestion in Patients with Acute Heart Failure with Reduced and Preserved Ejection Fraction: A Multicentre Study
title_sort prognostic role of sonographic decongestion in patients with acute heart failure with reduced and preserved ejection fraction: a multicentre study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917462/
https://www.ncbi.nlm.nih.gov/pubmed/36769421
http://dx.doi.org/10.3390/jcm12030773
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