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Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study

Mortality and re-admission rates for decompensated acute heart failure (AHF) is increasing overall and risk stratification might be challenging. We sought to evaluate the prognostic role of systemic venous ultrasonography in patients hospitalized for AHF. We prospectively recruited 74 AHF patients w...

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Autores principales: Torres-Arrese, Marta, Mata-Martínez, Arantzazu, Luordo-Tedesco, Davide, García-Casasola, Gonzalo, Alonso-González, Rodrigo, Montero-Hernández, Esther, Cobo-Marcos, Marta, Sánchez-Sauce, Beatriz, Cuervas-Mons, Valentín, Tung-Chen, Yale
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9966251/
https://www.ncbi.nlm.nih.gov/pubmed/36835816
http://dx.doi.org/10.3390/jcm12041281
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author Torres-Arrese, Marta
Mata-Martínez, Arantzazu
Luordo-Tedesco, Davide
García-Casasola, Gonzalo
Alonso-González, Rodrigo
Montero-Hernández, Esther
Cobo-Marcos, Marta
Sánchez-Sauce, Beatriz
Cuervas-Mons, Valentín
Tung-Chen, Yale
author_facet Torres-Arrese, Marta
Mata-Martínez, Arantzazu
Luordo-Tedesco, Davide
García-Casasola, Gonzalo
Alonso-González, Rodrigo
Montero-Hernández, Esther
Cobo-Marcos, Marta
Sánchez-Sauce, Beatriz
Cuervas-Mons, Valentín
Tung-Chen, Yale
author_sort Torres-Arrese, Marta
collection PubMed
description Mortality and re-admission rates for decompensated acute heart failure (AHF) is increasing overall and risk stratification might be challenging. We sought to evaluate the prognostic role of systemic venous ultrasonography in patients hospitalized for AHF. We prospectively recruited 74 AHF patients with a NT-proBNP level above 500 pg/mL. Then, multi-organ ultrasound assessments (lung, inferior vena cava (IVC), pulsed-wave Doppler (PW-Doppler) of hepatic, portal, intra-renal and femoral veins) were performed at admission, discharge, and follow-up (for 90 days). We also calculated the Venous Excess Ultrasound System (VExUS), a new score of systemic congestion based on IVC dilatation and pulsed-wave Doppler morphology of hepatic, portal and intra-renal veins. An intra-renal monophasic pattern (area under the curve (AUC) 0.923, sensitivity (Sn) 90%, specificity (Sp) 81%, positive predictive value (PPV) 43%, and negative predictive value (NPV) 98%), a portal pulsatility > 50% (AUC 0.749, Sn 80%, Sp 69%, PPV 30%, NPV 96%) and a VExUS score of 3 corresponding to severe congestion (AUC 0.885, Sn 80%, Sp 75%, PPV 33%, and NPV 96%) predicted death during hospitalization. An IVC above 2 cm (AUC 0.758, Sn 93.l% and Sp 58.3) and the presence of an intra-renal monophasic pattern (AUC 0. 834, sensitivity 0.917, specificity 67.4%) in the follow-up visit predicted AHF-related re-admission. Additional scans during hospitalization or the calculation of a VExUS score probably adds unnecessary complexity to the assessment of AHF patients. In conclusion, VExUS score does not contribute to the guidance of therapy or the prediction of complications, compared with the presence of an IVC greater than 2 cm, a venous monophasic intra-renal pattern or a pulsatility > 50% of the portal vein in AHF patients. Early and multidisciplinary follow-up visits remain necessary for the improvement of the prognosis of this highly prevalent disease.
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spelling pubmed-99662512023-02-26 Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study Torres-Arrese, Marta Mata-Martínez, Arantzazu Luordo-Tedesco, Davide García-Casasola, Gonzalo Alonso-González, Rodrigo Montero-Hernández, Esther Cobo-Marcos, Marta Sánchez-Sauce, Beatriz Cuervas-Mons, Valentín Tung-Chen, Yale J Clin Med Article Mortality and re-admission rates for decompensated acute heart failure (AHF) is increasing overall and risk stratification might be challenging. We sought to evaluate the prognostic role of systemic venous ultrasonography in patients hospitalized for AHF. We prospectively recruited 74 AHF patients with a NT-proBNP level above 500 pg/mL. Then, multi-organ ultrasound assessments (lung, inferior vena cava (IVC), pulsed-wave Doppler (PW-Doppler) of hepatic, portal, intra-renal and femoral veins) were performed at admission, discharge, and follow-up (for 90 days). We also calculated the Venous Excess Ultrasound System (VExUS), a new score of systemic congestion based on IVC dilatation and pulsed-wave Doppler morphology of hepatic, portal and intra-renal veins. An intra-renal monophasic pattern (area under the curve (AUC) 0.923, sensitivity (Sn) 90%, specificity (Sp) 81%, positive predictive value (PPV) 43%, and negative predictive value (NPV) 98%), a portal pulsatility > 50% (AUC 0.749, Sn 80%, Sp 69%, PPV 30%, NPV 96%) and a VExUS score of 3 corresponding to severe congestion (AUC 0.885, Sn 80%, Sp 75%, PPV 33%, and NPV 96%) predicted death during hospitalization. An IVC above 2 cm (AUC 0.758, Sn 93.l% and Sp 58.3) and the presence of an intra-renal monophasic pattern (AUC 0. 834, sensitivity 0.917, specificity 67.4%) in the follow-up visit predicted AHF-related re-admission. Additional scans during hospitalization or the calculation of a VExUS score probably adds unnecessary complexity to the assessment of AHF patients. In conclusion, VExUS score does not contribute to the guidance of therapy or the prediction of complications, compared with the presence of an IVC greater than 2 cm, a venous monophasic intra-renal pattern or a pulsatility > 50% of the portal vein in AHF patients. Early and multidisciplinary follow-up visits remain necessary for the improvement of the prognosis of this highly prevalent disease. MDPI 2023-02-06 /pmc/articles/PMC9966251/ /pubmed/36835816 http://dx.doi.org/10.3390/jcm12041281 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
Torres-Arrese, Marta
Mata-Martínez, Arantzazu
Luordo-Tedesco, Davide
García-Casasola, Gonzalo
Alonso-González, Rodrigo
Montero-Hernández, Esther
Cobo-Marcos, Marta
Sánchez-Sauce, Beatriz
Cuervas-Mons, Valentín
Tung-Chen, Yale
Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study
title Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study
title_full Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study
title_fullStr Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study
title_full_unstemmed Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study
title_short Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study
title_sort usefulness of systemic venous ultrasound protocols in the prognosis of heart failure patients: results from a prospective multicentric study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9966251/
https://www.ncbi.nlm.nih.gov/pubmed/36835816
http://dx.doi.org/10.3390/jcm12041281
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