Acute heart failure: sonographic B-lines are prognostic

  • Platz E & al.
  • JACC Heart Fail
  • 1 Oct 2019

  • International Clinical Digest
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Takeaway

  • For patients with acute heart failure (AHF), more B-lines on simplified lung ultrasonography (LUS) correlate with more in-hospital events and worse long-term outcomes.
  • Prospective studies are needed.

Why this matters

  • Few data exist on prognostic power of LUS-measured pulmonary congestion in AHF.
  • As congestion markers, B-lines have high inter-rater agreement and are more quantifiable than auscultated crackles.

Key results

  • Most patients had B-lines, even those without clinical or radiologic congestion.
  • Additional B-lines correlated with more primary in-hospital outcomes. 
    • For each higher B-line tertile: aOR, 2.25 (95% CI, 1.24-4.07; P<.007>
    • Adjustment included NT-proBNP.
  • As clinical congestion improved, B-line count dwindled (P<.001>
  • Over 6-month follow-up, long-term outcome occurred more often among patients with more LUS2 B-lines.
  • Prognostic power of B-lines postdischarge was stronger early on.

Study design

  • Prospective observational study in Boston and Glasgow (n=349).
  • Participants hospitalised with AHF underwent early LUS and, for some, again at discharge (LUS1 and LUS2, respectively).
  • Protocol scanned 4 zones and checked for pleural effusions.
  • Masked reviewers counted B-lines.
  • Outcomes:
    • In-hospital: composite of death, ICU admission, and need for intravenous inotropes or left-ventricular assist device.
    • Long-term: composite of death, heart failure readmission. 
  • Funding: NIH; British Heart Foundation.

Limitations

  • Unknown whether decongestive therapies should target B-line count.

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